BOOK-SMART Client Renewal Form

1
Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Service Level* This field is required.
Please Select
Please Select
Bronze - 4 to 5 presentations
Silver - 8 to 10 presentations
Gold - 16 to 20 presentations
4
Is all your information the same as last time?* This field is required.
Please Select
Please Select
Yes
No
5
What information needs updating?* This field is required.If on desktop, hold Ctrl or Command to select multiple
Please Select
Schedule
Total Workable Leads
Market Type
Lead Inbox
New Territories to Call
Local TimeZone
Zoom Info
Presentation Platforms
6
Are you working Response Cards, POS or Both?* This field is required.
Please Select
Please Select
Policy Owners
Response Cards
BOTH
7
How many workable POS leads do you have for our team to call?* This field is required.
Minimum 100 is required for the Bronze & Silver, 200 minimum required for Gold
8
How many workable Response Card leads do you have for our team to call?* This field is required.
Minimum 100 is required for the Bronze & Silver, 200 minimum required for Gold
9
Which Lead Inbox do you want our team to call from?* This field is required.
Please Select
Please Select
ALL
In-Town
Road Trip
List Lead
Lapse Lead
10
Field Days* This field is required.
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
11
Any schedule exceptions* This field is required.
Ex. Personal Appointments etc.
12
Start Date & Time* This field is required.
Date
Month
Day
Year
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Hour
20
00
10
20
30
40
50
Minutes
PM
AM
PM
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First Appt Time* This field is required.
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Hour
00
10
20
30
40
50
Minutes
PM
AM
PM
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Last Appt Time* This field is required.
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2
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Hour
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10
20
30
40
50
Minutes
PM
AM
PM
15
What US states will you need us to call for?* This field is required.If using a desktop, please hold CTRL / Command when selecting multiple territories
Please Select
ALL
NONE
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
16
What CAN provinces will you need us to call for?* This field is required.If using a desktop, please hold CTRL / Command when selecting multiple territories
Please Select
ALL
NONE
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
17
What is your local timezone?* This field is required.
18
What is your zoom link?* This field is required.
19
Presentation Platforms* This field is required.If on Desktop Select Ctrl / Command to select multiple
Please Select
Zoom
Google Duo / Meets
Facetime
Whatsapp
20
Comments
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