Life Insurance Score

*The use of this form is not a secure medium and personal information should be transmitted by more secure means. By submitting an e-mail address and/or telephone number, you are requesting that we contact you or your referral on your behalf or the person you specify here. Your [name and] contact information are required, but will not be used other than to distribute the communication you request with Walton Financial Inc. For your convenience, you also have the option of contacting us by email. Please note that no email is 100% secure. We ask that you only provide us with your contact information and your question. Do not include sensitive information such as income, social insurance number.