Our Mission Statement

Dating back from 1872 our mission is clear:

To serve our clients with the utmost respect, integrity and professionalism while providing a comprehensive risk management program at competitive pricing

Protection, Integrity, and Service
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Life Insurance Quotation
 
Submit this form to be contacted by a licensed financial professional or an appointed independent insurance agent1.
* Required Fields
Yes No
  • Do you have a hazardous occupation (such as: underground mining, high-rise construction, offshore drilling, explosives handling, etc.)?
Yes No
  • Do you participate in any hazardous sports or activities (such as sky diving, mountain climbing, parachuting, scuba diving, etc.)?
Yes No
  • Have you ever been found guilty of driving under the influence (DUI/DWI) or of reckless driving?
Yes No
  • Have you had your drivers license suspended
    or had an "at fault" accident within the last three years?
Yes No
  • Have you had any motor vehicle moving violations within the last three years?
  • Which statement best describes your use of tobacco or nicotine products (including cigarettes, cigars, dip, snuff, chewing tobacco, pipe tobacco, and nicotine patches or gum)?
    Never or not within the last five years
    Not within the last 3 years
    I have not used cigarettes within the last 12 months
    I have smoked cigarettes within the last 12 months

Yes No
  • Do you have a medical history of heart disease, stroke, diabetes, or cancer?
Yes No
  • Do you have a history of high blood pressure or high cholesterol?
 
 
 
*First Name *Last Name
*Address 1
Address 2
*City *State *Zip
*Daytime Phone Evening Phone
- - - -
*Email
*Are you currently an Agency client? Yes No
*Age *Gender
*Height *Weight
ft. in. lbs.
*When do you plan to purchase life insurance?
*I am interested in receiving a quote on (check all that apply):
Term life Whole Life Other Permanent Life
*Coverage Amount *Term Coverage Duration (Term Coverage Only)
1By completing the form above and clicking on the "Submit" button, I request that a Haines & Haines/T.C. Irons representative contact me by telephone, email or mail using the information I have supplied above even if I have previously requested not to receive marketing mail, paper or electronic.
a
Privacy Policy-We routinely collect personal and/or business information that is needed as part of the quoting and underwriting process.  We also collect the same information as part of service and update activities.  The Haines & Haines/T.C. Irons Agency will not share that information, or use it in any other way, with outside parties, vendors, etc.

Policy Coverage and Disclaimer

Haines & Haines/ T.C. Irons
230 High Street PO Box 158- Burlington, NJ 08016
Phone: 609.387.0606
Fax: 609.387.5337		 708 Stokes Road,
Suite A
Medford, NJ 08055
Phone: 609.953.2282 
Fax: 609.953.7719
W.C. Hughes Agency of  Florence Inc
200 Delaware Avenue, Roebling,  NJ 08554
Phone: 609.499.0237 
Fax: 609.499.4077		 Wesley Insurance Service Agency
200 Delaware Avenue, Roebling,  NJ 08554
Phone: 609.499.0517
Fax: 609.538.4077