<?xml version="1.0" encoding="utf-8"?>
<InsuranceRequest xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:xsd="http://www.w3.org/2001/XMLSchema">
	<AffiliateInfo>
		<PartnerID>3</PartnerID>
		<Token>G15QncRptYzJftqUauVyodKvsoZWxArrfsgdetg</Token>
		<TrackingCampaign>MyCampaign</TrackingCampaign>
		<LeadSourceID>InHouse</LeadSourceID>
		<LeadIdToken>3DDAB3DF-978B-4E65-D2C6-79A3BC71D155</LeadIdToken>
		<ProductionEnvironment>true</ProductionEnvironment>
	</AffiliateInfo>
	<LeadMetaData>
		<LeadBornOnDateTimeUtc>2016-06-01T01:00:01</LeadBornOnDateTimeUtc>
		<IpAddress>75.27.97.10</IpAddress>
		<UserAgent>Mozilla/5.0 (Windows NT 6.3; WOW64; Trident/7.0; rv:11.0) like Gecko</UserAgent>
		<TcpaCompliant>true</TcpaCompliant>
		<TcpaText>By submitting your quote request, you represent that you are at least 18 and agree to our Privacy Policy and Terms of Use. You also authorize us and/or its marketing partners to contact you for marketing/telemarketing purposes at the number and address provided above, including your wireless number if provided, using live operators, automated telephone dialing systems, pre-recorded messages, text messages and/or emails. You are not required to consent as a condition of purchasing goods or services and may revoke consent at anytime.</TcpaText>
	</LeadMetaData>
	<LeadTypeID>5</LeadTypeID>
	<ZipCode>43215</ZipCode>
	<ContactInfo>
		<FirstName>John</FirstName>
		<LastName>Doe</LastName>
		<Address>123 Main St</Address>
		<ZipCode>43215</ZipCode>
		<City>Columbus</City>
		<County>FRANKLIN</County>
		<State>OH</State>
		<PhoneDay>9122074914</PhoneDay>
		<PhoneEve>9128524606</PhoneEve>
		<PhoneCell>9122074914</PhoneCell>
		<Email>Johndoe@test.com</Email>
	</ContactInfo>
	<LifeInsurance>
		<PersonInfo>
			<DOB>1956-05-03</DOB>
			<Gender>Female</Gender>
			<Height_FT>5</Height_FT>
			<Height_IN>11</Height_IN>
			<Weight>142</Weight>
			<Tobacco>false</Tobacco>
		</PersonInfo>
		<MedicalHistory>
			<Relative_Heart>false</Relative_Heart>
			<Relative_Cancer>false</Relative_Cancer>
			<Medication>false</Medication>
			<Medical_Treatment>false</Medical_Treatment>
			<Hospital>false</Hospital>
			<Comments>None</Comments>
		</MedicalHistory>
		<MajorMedical>
			<AIDS_HIV>false</AIDS_HIV>
			<Alcohol_Drug_Abuse>false</Alcohol_Drug_Abuse>
			<Alzheimers_Disease>false</Alzheimers_Disease>
			<Asthma>false</Asthma>
			<Cancer>false</Cancer>
			<Cholesterol>false</Cholesterol>
			<Depression>false</Depression>
			<Diabetes>false</Diabetes>
			<Heart_Disease>false</Heart_Disease>
			<High_Blood_Pressure>false</High_Blood_Pressure>
			<Kidney_Disease>false</Kidney_Disease>
			<Liver_Disease>false</Liver_Disease>
			<Mental_Illness>false</Mental_Illness>
			<Pulmonary_Disease>false</Pulmonary_Disease>
			<Stroke>false</Stroke>
			<Ulcer>false</Ulcer>
			<Vascular_Disease>false</Vascular_Disease>
		</MajorMedical>
		<Occupation>Telecommunications</Occupation>
		<DUI>false</DUI>
		<Hazards>
			<Pilot>false</Pilot>
			<Felony>false</Felony>
			<OtherHazards>false</OtherHazards>
			<Comments>None</Comments>
		</Hazards>
		<CurrentInsurance>
			<CurrentlyInsured>true</CurrentlyInsured>
			<CurrentPolicy>
				<Carrier>Blue Cross / Blue Shield</Carrier>
				<Expiration>2013-02-21</Expiration>
				<InsuredSince>2010-02-06</InsuredSince>
			</CurrentPolicy>
		</CurrentInsurance>
		<RequestedCoverage>
			<CoverageType>Term 15 Years</CoverageType>
			<CoverageAmount>3000000</CoverageAmount>
		</RequestedCoverage>
	</LifeInsurance>
</InsuranceRequest>