Today's Date:
*
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Month
-
Day
Year
Customer's Reward Status:
*
Silver
Gold
Platinum
Diamond
Calculator (Open If Needed)
Core Services:
What Services Does Your Customer Have Currently?
Internet
TV
Home Phone
Home Security
Xfinity Mobile
How much is your customer's current core bill BEFORE making any changes?
What services will you recommend for your customer?
Internet
TV
Home Phone
Home Security
Xfinity Mobile
How much is your customer's current core bill AFTER switching to Xfinity Mobile?
XM ADD ONS (Qualifying Event):
What Qualifying Event Would Your Customer Qualify For?
Please Select
50% iPad 11th Gen $26.94
Samsung Galaxy Tab A11+ (Premium) $37.77
Samsung Galaxy Tab A11+ (Intro) $27.77
Landline To XM Port $0
Landline To XM Port Premium $10
Landline To XM Port $20
Landline To XM Port $30
Add A BYOD Watch $10
Apple Watch SE ($300 Off) $10
Apple Watch SE ($150 Off) $14.16
Galaxy Watch 8 ($300 Off) $10.83
Galaxy Watch 8 ($150 Off) $14.99
New Cost For Xfinity
Preview The Form Below To SHOW YOUR CUSTOMER:
Customer's First Name:
*
What Is Your Name:
*
What Is Your Store:
*
Please Select
Bourbonnais Xfinity Store
Burbank Xfinity Store
Cicero Xfinity Store
Dekalb Xfinity Store
Elkhart Xfinity Store
Evanston Xfinity Store
Evergreen Park Xfinity Store
Frankfort Xfinity Store
Glenview Xfinity Store
Greeneville Xfinity Store
Hammond Xfinity Store
Johnson City Xfinity Store
Kildeer Xfinity Store
Michigan City Xfinity Store
Oak Ridge Xfinity Store
Round Lake Beach Xfinity Store
Schererville Xfinity Store
Skokie Xfinity Store
South Bend Xfinity Store
South Knoxville Xfinity Store
Tinley Park Xfinity Store
Uptown Xfinity Store
Valparaiso Xfinity Store
DM Submission
Did you sell this lead by using the Mobile Quick Sheet on the spot?
*
Please Select
Yes
No
Only submit "Yes" if your customer is leaving the store right now with Xfinity Mobile. We are looking to track on the spot sales by using the Whole Home Solution.
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