Money Saving Services Survey
This survey will help me explore your best options to reduce your bills and/or capture a better value. Think of me as your personal Treasure Hunter - helping you find the hidden savings in the monthly bills you're already paying so you can invest it in the things that matter to you the most!
Who referred you? Name of the Independent Business Owner
*
First Name
Last Name
IBO Number (if you know it)
Your Name
*
First Name
Last Name
Address (No P.O. Box)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Number
*
Please enter a valid phone number with area code
Format: (000) 000-0000.
Email
*
example@example.com
HEALTH CARE
Do you have health insurance?
Yes
No
How many members are in your plan?
How much is your monthly payment?
Are you open to a free no obligation quote to see if you can save money?
*
Yes
No
If yes, please provide the birthday of the oldest member in the household.
Date of Birth:
-
Month
-
Day
Year
Birthday of the oldest member
Number of members:
IDENTITY THEFT PROTECTION
Have you or your family ever been victims of identity theft?
Yes
No
Do you currently have Identity Theft Protection?
*
Yes
No
Who is your current provider?
How much is your monthly protection?
Do you currently have Anti-Virus / VPN Device Protection for your phones, tablets & laptops?
*
Yes
No
Who is your current provider?
How much is your monthly protection?
Are you open to explore our cyber-security/identity theft protection options?
*
Yes
No
If yes, how many adults?
If yes, how many kids?
SECURITY & AUTOMATION
Do you have a doorbell camera or smart home equipment?
*
Yes
No
Is it integrated with your Security system?
Yes
No
I do not have a Security System
Who is your current provider?
How much is your monthly bill?
If yes, when does your contract(s) expire?
-
Month
-
Day
Year
Date
Are you open to explore our security options?
*
Yes
No
What is the best day and time to get a free quote from Vivint?
Date
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Time Zone:
*
Central Time
Eastern Time
Mountain Time
Pacific Time
GAS & ELECTRICITY
(available only in deregulated states)
What state do you live in?
Please Select
California
Connecticut
Georgia
Illinois
Indiana
Kentucky
Massachusetts
Michigan
Ohio
Texas
Delaware
Maine
New Hampshire
Pennsylvania
Virginia
Washington D.C.
Maryland
New Jersey
Rhode Island
What energy plan do you currently have?
Fixed Rate
Variable Rate
I'm not sure
Are you open to explore our energy options?
*
Yes
No
NOTE: Please have your most recent utility bill available when we have our follow up conversation.
MOBILE
Current provider?
*
How many lines do you have?
*
How much is your monthly plan?
*
Do you owe money on your devices? (installment payments)
Yes
No
I'm not sure
Are you open to explore our mobile options?
*
Yes
No
INTERNET
What type of internet connection do you currently have?
*
Fiber
Cable
No Internet Connection
Internet Speed?
ex: 300 Mbps, 500 Mbps, 1000 Mbps, etc.
Current provider?
Bundled with:
None
Television
Phone
Mobile
Primary Internet Activity:
Work from home
Streaming
Gaming
Other
How much is your monthly bill?
*
When does your contract(s) expire?
Are you open to explore our internet options?
*
Yes
No
TELEVISION
Do you currently pay for TV?
*
Yes
No
Current provider?
Is your service:
Satellite
Cable
Streaming
How much is your monthly bill?
*
When does your contract(s) expire?
Are you open to explore our TV options?
*
Yes
No
ON-LINE BANKING (FINTECH)
We are about to announce on-line banking - higher interest, lower fees, better mortgages & loan rates etc. Are you open to explore our on-line banking options?
*
Yes
No
Coming soon, we will be able to offer HOME and AUTO insurance Services. Would you like us to follow up with you when this is added to our list of services?
*
Yes for Home and Auto rates
No potential savings
Thank you!
I appreciate you taking the time to fill out this survey. Your support of my business means the WORLD to me. I look forward to helping you and I appreciate any individual or small business referrals you can think of. Have a fabulous day!
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