Small Business Owner Protection & Benefits Assessment

As a small business owner, your income, your family, and your team all depend on you. This assessment helps you see where your protection, benefits, and succession plans stand today—and where they may need attention.

Review your personal and business protection (life, disability, key person, buy-sell).
Identify gaps in benefits for you, your partners, and your team.
Explore options tailored to your revenue, goals, and growth plans.

First Name *

Last Name *

Phone *

Email *

State

Business Name

Type of Business

Years in Business

Number of Employees (Including You)

Approximate Annual Revenue

Top Priority Right Now

Current Coverage in Place

Biggest Concerns if Something Happened to You or a Key Person

What Would You Like This Plan to Do for You?

Best Time to Reach You

Consent to be contacted *

By checking this box and clicking “Submit My Small Business Owner Protection & Benefits Assessment”, you agree that Chris A. Roth and/or our partner carriers may contact you at the phone number and email address provided (including by autodialed, prerecorded, or artificial voice calls and text/SMS messages) about life insurance, and related products. You understand that your consent is not a condition of purchase and that you may revoke consent at any time. Message and data rates may apply. Your information is confidential and will only be used to provide your personalized recommendations.

Privacy Policy | Terms of Service