IUL LEAD APPLICATION

(WHILE WE WANT TO HELP AS MANY AGENTS AS POSSIBLE WE DON'T ACCEPT EVERYONE)

First Name *

Last Name *

Phone *

Email *

How long have you been selling insurance *

Have you purchased leads from a 3rd party vendor before? *

Yes, but I never used it

Yes, I liked it but looking for something more

No, this is my first time

What level of production do you submit on average per month? *

What is one of the main reasons you are interested in using Lead Champ Pro Leads?

We're you referred by another agent? (First and Last name)

By checking this box, I acknowledge that I have watched the "Expectations" video for Lead Champ Leads in its entirety. I further agree and confirm that I fully understand the details, requirements, and obligations of the program as explained in the video. I understand that this acknowledgment constitutes my informed agreement to participate in the program under the terms outlined. Additionally, I accept that my participation may be subject to the expectations and conditions detailed within the program materials.

Lead Champ Pro