REI Quote Request Need Help? schedule a call Please enable JavaScript in your browser to complete this form.Tell us about yourself. - Step 1 of 3Name *FirstLastPhone *Email *State *NextDate of Birth *Height *Weight *Nicotine/Tobacco Usage? *NeverCigarettesCigarsNicotine Gum/LozengeOtherWhen was the last time you used it?CurrentlyWithin the last 2 yearsOver 2 yearsAny Medical Issues? *YesNoMaybeHistory of asthma, cancer, diabetes, sleep apnea, etc.Please explain your medical history. *PreviousNextDo you know how you would like to fund your policy? *YesI'm not sure yet.What's your funding choice? *MonthlyOver a few years.A single lump sum.What's your budget? *PreviousSubmit