You can always press Enter⏎ to continue
Lead Request Form
Hi there, please fill out and submit this form.
12
Questions
START
1
Name
*
This field is required.
First Name
Last Name
Previous
Next
Submit
Press
Enter
2
Phone Number
*
This field is required.
Please enter a valid phone number.
Previous
Next
Submit
Press
Enter
3
Email
*
This field is required.
example@example.com
Previous
Next
Submit
Press
Enter
4
Company Name
*
This field is required.
Previous
Next
Submit
Press
Enter
5
Company Position
*
This field is required.
Please Select
Sales Rep
Sales Manager
Owner
Other
Please Select
Please Select
Sales Rep
Sales Manager
Owner
Other
Previous
Next
Submit
Press
Enter
6
Desired # of Leads
*
This field is required.
Please Select
0-50
50-100
100-250
250+
Please Select
Please Select
0-50
50-100
100-250
250+
Previous
Next
Submit
Press
Enter
7
Desired Payment Plan
*
This field is required.
Please Select
Pay Per Appointment (Flat Rate)
Performance Pay (Metric Tiered Structure)
Pay As You Profit (Pay Upon Closed Business)
Bulk Purchase
Please Select
Please Select
Pay Per Appointment (Flat Rate)
Performance Pay (Metric Tiered Structure)
Pay As You Profit (Pay Upon Closed Business)
Bulk Purchase
Previous
Next
Submit
Press
Enter
8
How would you pay for these inspections?
*
This field is required.
Please Select
Credit Card
ACH
Cash
Check
Debit Card
Other
Please Select
Please Select
Credit Card
ACH
Cash
Check
Debit Card
Other
Previous
Next
Submit
Press
Enter
9
If you show up to an inspection and it does not run for some reason, what do you do?
*
This field is required.
Blame the lead generation company and demand a refund
Realize that sales is a numbers game and this will happen
Leverage this inspection and try to get more booked from this "neighborhood in"
Do the inspection anyways and follow up with results
Stop by neighbors and see if you can earn their business
Other
Previous
Next
Submit
Press
Enter
10
If the homeowner has never filed a claim before and has damage, how do you proceed?
*
This field is required.
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
Previous
Next
Submit
Press
Enter
11
What is your current lead acquisition cost?
*
This field is required.
$0-$50
$50-$100
$100-$150
$150-$200
$200-$250
$250+
Previous
Next
Submit
Press
Enter
12
What current marketing methods are you utilizing?
*
This field is required.
Canvassing
Social Media Ads
Landing Pages
Direct Mail
Door Hangers
Email Marketing
Telemarketing
Referrals
Yard Signs
Vehicle Decals
Trade Shows
Networking Groups
Insurance Agent Referrals
Previous
Next
Submit
Press
Enter
Should be Empty:
Question Label
1
of
12
See All
Go Back
Submit