American Mortgage Protection Group

Discover Peace of Mind

Every 11 seconds a property defaults in the U.S.*

Can your family afford the risk of foreclosure?

Discover peace of mind now with Mortgage Protection Insurance.


Simply fill out the form below or contact us for a FREE quote today!
1-866-948-7999 or mail@ampg.biz

Want to join the AMPG team as an agent?
Contact us!
We look forward to hearing from you.
For complete details at no cost or obligation, please complete the following form for the borrower and all co-borrowers.

Please separate borrower information by a semicolon to avoid filling out a separate form for each borrower. For example, for the "Date of Birth field", you would fill in "month/day/year; month/day/year" to correspond to the date of births for the borrower and co-borrower.
Mortgage Balance
Remaining Years of Mortgage
Full Name
Date of Birth
Sex
Height
Weight
Smoker (yes/no)
Have You Ever Had: 1) High Blood Pressure? (yes/no)
2) High Cholesterol? (yes/no)
3) Heart Attack, Stroke or Cancer? (yes/no)
4) Diabetes? (yes/no)
Occupation
Home Phone
Cell Phone
Work Phone
Call at: (Home/Work)
Best Time to Call:
E-mail
Name of Person Completing This Form
*CNNMoney.com, Record 3 million households hit with foreclosure in 2009