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Auto Insurance


Jeff Mangelli

Jeff Mangelli


  7451 Auburn Blvd # B
  Citrus Heights, CA

  Phone: (916) 728-4050
  Fax:      (916) 728-4070

CA Lic#: 0C22228


Contact Me

Please contact the Webmaster if you have any comments or questions about this web site

First Name
Last Name
Address 1
Address 2
Zip Code
Daytime Phone
Evening Phone
Email Address

 Date of Birth  
 Height   ft. in.
Do you currently smoke? Yes No
 Will this policy replace an existing one?   Yes No
If Yes, who is your current company?
And what is the expiration date?

 Amount of Coverage
What type of insurance are you interested in?

Term Life

Whole Life

Universal Life

Variable Life


If you are requesting Life Insurance for your spouse and/or any dependents, please fill out this section
  1   2   3
  Date of Birth      

 Have you, your spouse or any dependents you are recieving a quote for ever been denied coverage for a health reason?
 If yes, please describe when, what company, and why you were denied