Owner Lead Intake Form

Owner Lead Intake Form

Owner Lead Intake Form

(FICA + HealthCues)
Which program is this appointment for?*
- FICA QUALIFICATION
- How many W-2 employees do you have?
- Do you have tipped employees?
- Estimated annual revenue?
- What type of restaurant or business do you operate?
- HEALTHCUES QUALIFICATION
- Do you currently offer a healthcare plan to employees?
- How many W-2 employees do you have?
- Do your employees make at least $17,000 per year?
- Who is your current healthcare provider or broker?
- DOCUMENT READINESS
- Payroll JournalW32022 Business Tax Return2023 Business Tax Return2024 Business Tax ReturnOther Payroll ReportsNot Sure / Need Help
- Business Details
- Business Name*
- Business Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Type of Business*
- Owner / Decision Maker Information
- Full Name*
  
  First NameLast Name
- Phone Number*
  Format: (000) 000-0000.
- E-mail*
  example@example.com
- Employee & Operations Info
- Total Number of W-2 Employees *
- Does the business have tipped employees?*
- Are tips reported through payroll?*
- Program Interest Tag
- Which program is this lead relevant for? *
- Does the owner want more information?*
- Appointment / Transfer Info
- Was a live transfer attempted?*
- Appointment Status *
- If appointment booked — Date & Time
- Notes
- Setter Notes
- Should be Empty: