• Diabetic Leads Order Form

    Diabetic Leads Order Form

    Fill out the form accurately for campaign registration
  • Relationship to Referral: My referral is:*
  • Your campaign will begin as soon as funds are confirmed. If you wish to schedule a specific date and time for this campaign to begin, choose the date and time below.
     - -
  • States Licensed? (Check all that apply) NOTE: CHECK ONLY THE STATES FROM WHICH YOU WISH TO RECEIVE LEADS [Minimum = 4 states]*
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Do you use an online scheduling software (I.e. Calendly, etc) that you would like for us to share with each new lead prospect?*
  • Do you want us to automatically send your Ethos link to your lead?*

  • Choose Order Type

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    Diabetic Leads [Quantity = 20-49]. Leads are generated from compliant ads marketed across social media platforms or keyword search Google traffic. Minimum of (20).
    Diabetic Leads [Quantity = 20-49]

    Leads are generated from compliant ads marketed across social media platforms or keyword search Google traffic. Minimum of (20). 

    $19.00$19.00
    Item subtotal:$0.00$0.00
      
    Diabetic Leads [Quantity = 50 and up]. Leads are generated from compliant ads marketed across social media platforms or keyword search Google traffic. Minimum of (50).
    Diabetic Leads [Quantity = 50 and up]

    Leads are generated from compliant ads marketed across social media platforms or keyword search Google traffic. Minimum of (50). 

    $15.00$15.00
    Item subtotal:$0.00$0.00
      
    3-Page Mobile Story. Storyboard containing your image, DCS branding, license images, and integrated booking calendar. Purchase includes html files. Hosting available. See example below.
    3-Page Mobile Story

    Storyboard containing your image, DCS branding, license images, and integrated booking calendar. Purchase includes html files. Hosting available. See example below.

    $100.00$100.00
      
    Personal Landing Page. Landing page with DSC branding. You may add your personal branding as well. Includes your choice of "Book Now" button directing traffic to your scheduler, or integrated Calendly for booking. Includes html files. Hosting available. See example below.
    Personal Landing Page

    Landing page with DSC branding. You may add your personal branding as well. Includes your choice of "Book Now" button directing traffic to your scheduler, or integrated Calendly for booking. Includes html files. Hosting available. See example below.

    $250.00$250.00
      
    Subtotal
    $0.00$0.00
    Tax
    $0.00$0.00
    Total
    $0.00$0.00

  • Sample mobile story:  https://diabeticeverything.com/paul

    Sample landing page:  https://go-excel.com/paul-landing-page.html

     

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