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LEAD ORDER FORM

Please provide the demographics such as age, zip codes or counties that you would like us to target. Please narrow to only 5 entries per order.
Lead Packages*
Service Agreement
I agree to purchase Lead order with Life Business and Benefits. I agree that life business and benefits will provide for services and is not responsible for interest or disinterest in buying the product. I agree to pay the amount negotiated between myself and my sales representative and I agree that there is no refund offered on this plan.
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Congratulations on taking the first step to partnering with Life Business and Benefits and our lead packages. We strive to be the best insurance practice in the market and we want you to have the tools necessary to succeed with us through our exclusive Lead Programs.  


Please fill out this Lead Order Form to  begin the process of receiving your leads.  Once the form has been completed please allow 24-36 hours to receive an invoice for the services requested.  If you have any other questions, please contact your marketing representative.  Thank you for choosing to partner with us.


Lead Packages