B2B BUSINESS SUBMISSION
B2B Connector
Product Submitting (choose one):
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BizCare360
BizLending360
BizBenefits360
Business Name
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Contact Name
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Contact Company Title
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MUST BE DECISION MAKER
Contact Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Contact Email
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example@example.com
Business Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
# of W-2 Full-Time Employees
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Work 30+ hours per week
# of W- Part-Time Employees
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Work 20-29 hours per week
Are Employees paid Hourly, Salaried or Commissioned Based?
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Please Select
Hourly
Salaried
Commission Based 1099
Please Only Select One
# of 1099 Employees or 1 for Self Employed
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Does Business currently provide Health Insurance?
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Yes
No
% Percentage of employees who have health insurance through:Please provide your best estimate.
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Rows
Percentage
Your Company Provides
Spouse Provides From Employer
Parents Provide
Unknown/ACA-Marketplace/Medicare/Medicaid
How Do You Know The Business Prospect?
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Please Select
Friend or Family
Business Relationship
Referral From Other
Cold Call/Cold Outreach
Please Only Select One
B2B CONNECTOR Advocate NAME
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First Name
Last Name
Advocate CELL Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Advocate Email
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example@example.com
Be sure to text Kurt Weinhauer at 727-809-0383 for availability for all Biz Care 360 deals. Communicate quickly as Kurt has full access to the Discovery Call Calendar.
Be sure to text Kirt Francis at 435-256-0888 for availability for all Biz Benefit 360 deals. Communicate quickly as Kirt has full access to the agents calendars.
(BizCare Only) HOW WOULD YOU LIKE YOUR DEAL TO BE WORKED?
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Option 1: Submit Business and Then Hand Off to a Closer Work & Close the Deal. You earn up to $5.00 per employee per month when they enroll and remain on the program.
Option 2: You Submit Business and then YOU Work & Close your deal yourself in a reasonable time frame.
This submission is not for BizCare and is not applicable.
By signing below you acknowledge your Deal Handling Choice
I would like to be on the Discovery ZOOM (Only Fill Out For BizCare360 or BizBenefits360)
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YES
NO
Notes: Be Detailed
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By Submitting this Business Deal to B2B Connector I acknowledge I have read, understand and agree to the May 29, 2025 Non-Responsive Advocate Contract Addendum represented below. Click the 3 Lines on left below to enlarge view.
Addendum Acknowledgement Signature
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