Customer Appreciation Sponsorship Form
We are pleased to announce that all past & present clients now have new benefits at NO COST TO YOU! These benefits are jointly sponsored with Pinky Promise Beauty & Globe Life – AIL Division / Icaza Organization, a company servicing working families for more than 75 years. Everyone will also receive a FREE Life Insurance Need Analysis for themselves and/or family.
Registered by
Please Select
Carmelo Lugo
No-Cost Benefits (check any and all)
YES! I want to receive a Child Safe Kit.
YES! I want to receive a Will Kit & Testament.
YES! I want to receive the AIL Plus Discount Program.
YES! I want to receive a $2,000 Accidental Death & Dismemberment Policy.
Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Number
*
Please enter a valid phone number.
Email
*
example@example.com
Appointment
Submit
Should be Empty: