Lead Submission - Tax Preparers
A one time $50 referral bonus per client (regardless of the number of services referred to) will be given upon payment of service. Bonuses issued quarterly.
Primary Contact Name
First Name
Last Name
Preferred Name
Spouse Name
First Name
Last Name
Preferred Name
Primary Contact Phone Number
Please enter a valid phone number.
Primary Contact Email
example@example.com
Referral Source
Please Select
bhanu@clearstrategyteam.com
laurie@clearstrategyteam.com
marty@clearstrategyteam.com
raedeane@clearstrategyteam.com
eniko@clearstrategyteam.com
richard@clearstrategyteam.com
felicity@clearstrategyteam.com
Address
Street Address
Street Address Line 2
City
State
Postal / Zip Code
Which leads are being submitted?
Health Insurance (not eligible for bonus)
Group Health Insurance
Life Insurance (not eligible for bonus)
Home & Automotive Insurance (not eligible for bonus)
Mortgage Funding (not eligible for bonus)
Estate Planning
Financial
Health Insurance
Products Inquired
Medicare Advantage
Medicare Supplement
Prescription Drug Plan(PDP)
LTC/STC
ACA(Obamacare)
Other
Client Age
Case Notes & Information
Life Insurance
Life Insurance type
Term
Whole
Universal
Other
Estimated Coverage Needed ($)
Case Notes & Information (please specify purpose, term, etc.)
Home & Automotive Insurance
Primary Applicant Date of Birth
-
Month
-
Day
Year
Date
Does the applicant rent or own?
Rent
Own
Additional Properties (Street Address - Address, Zip Code, City, State)
Vehicles - Make, Model, Year
Case Notes & Information
Mortgage Funding
Borrower Date of Birth
-
Month
-
Day
Year
Date
Co-Borrower Date of Birth
-
Month
-
Day
Year
Date
Estimated Property Value ($)
Loan Type:
New Home Purchase
Refinance
Reverse Mortgage
Other
Existing Loan Balance ($)
Existing Loan Term
Please Select
10
15
20
30
Existing Loan APR
Case Notes & Information:
Estate Planning
Referred to Simplify Estate Planning
Trust Estate Plans starting at $2,000
Included with Trust Estate Plans:
Lifetime Amendments to the Trust
Pour-over Will
Healthcare Power of Attorney
Durable Power of Attorney
Transferring Two (2) Michigan Deeds
Docubank (HCPOA & Emergency Contacts Card) Included for 5 years
Out of State Deeds - USDeeds.com (Third Party) Fees vary based on State
Estate Plan:
Individual - Trust Estate Plan
Individual - Will Estate Plan
Married Joint - Trust Estate Plan
Married Separate - Trusts Estate Plan
Married - Will Estate Plan
Current Estate Plan Review (not eligible for bonus)
Trust Amendment (not eligible for bonus)
Deed (not eligible for bonus)
Case Notes & Information
Financial
Received statements/documents?
Yes
No
Investable Assets Amount
Please Select
$0-$100k
$100k-$250k
$250k-$500k
$500k-$1mil
$1mil+
Case Notes & Information
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