Tell Us About Your Company...

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Thank you for your interest in our Video Sales Leads and Appointments program. Please complete the form below so we can have the most accurate information possible.

Name(Required)

First Last

Business Name:(Required)

Phone Number:(Required)

Email(Required)

Website address (URL):(Required)

Confirm Product Type and Price

Safe Money Product Chosen

Safe Money Marketing Product Selected:(Required)

Price:

Lead Management

Who is the point of contact at your office?(Required)

Additional Email Address(Required)

Enter in the additional email address(es) you would like leads sent to. Please separate multiple email addresses with a comma.

Program Information

Choose your webinar topic(Required)

AnnuityRank

Social Security

Taxes & Retirement

Estate Planning for Everyone/LegacyLock

Other

Please note: Alternate topics are not guaranteed per our best practices.

Desired Service Region:(Required)

1. DMA 2. Entire State(s) of ___ 3. County List within the state of ___ 4. A ___ mile radius of the zip code ___. *If you do not want the radius to span across state lines, please specify the states that can be included in this radius. The more areas you expand to and/or service will lead to a greater volume of quality leads.

Please provide any specific details if necessary.

Program Details

What Online Calendar Technology do you use?(Required)

*Agents will only see appointments on calendar. The two major calendar integrations we currently work with is Outlook and Google Calendar.

Presenter Information

Presenter's Name

First Last

Please provide a company or personal biography for the presenter.(Required)

You can also provide a link to the bio if you prefer.

What is the presenter's state license number?

If applicable.

Is the presenter a registered rep?(Required)

Yes

Please write out any disclosures we will need to include.(Required)

We will need these every time you fill out a questionnaire to make sure your campaign is not delayed.

Please upload a photo/headshot of the host.

Max. file size: 2 GB.

Please upload your company logo

Max. file size: 2 GB.

Submission Review

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Terms and conditions apply for guaranteed reimbursements:

View our Best Practices/Terms and Conditions HERE.

Terms & Conditions

I agree to the terms and conditions

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Payment:

Total

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