BIZ BENEFITS SUBMISSION FORM

Contact Name

Business Name

if for individual type: N/A

Contact Company Title

MUST BE DECISION MAKER if for individual type: N/A

Contact Phone Number

Format: (000) 000-0000.

Contact Email

Contact Date of Birth

Business Address - or Individual

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Coverage is needed for:

Level of Coverage needed:

# of Employees or 1 for Individual

if for individual type: N/A

If for Individual : Date of Birth

Benefits offered by Company

How Do You Know The Prospect?

Prospects Best Day to be contacted?

Best Times

Time Zone

Other Contact Info / Notes

Text Kirt Francis at 435-256-0888 for availability for all Biz Benefit deals. Communicate quickly as Kirt has full access to the agents calendars.

Discovery Call is Scheduled For:

IF NOT SCHEDULED YET TYPE: TBD - Closing Advocate Will Contact Prospect to confirm discovery call date and time.

Has Discovery Zoom Date and Time been confirmed with Prospect?

If Not Scheduled - Give Two Dates and Times Best For Discovery Call - After 24 hours

Notes: Be Detailed

B2B CONNECTOR Advocate NAME

First NameLast Name

Advocate CELL Number

Please enter a valid phone number.Format: (000) 000-0000.

Advocate Email

example@example.com

I would like to be on the Group Discovery ZOOM - Once you receive your email invite, please click on "YES" that you are attending.

If you chose to be on the Group Discovery zoom, you will get an email confirmation. Check yes on the email that you will be attending.

BizBenefits Submission