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Submit your client’s credit card debt information
phpdebtsolutions_ej6yxe
2022-05-24T11:24:10-07:00
Step 1 of 4
25%
Let's start off by knowing what state your client is in.
What state is your client in?
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Alabama
Arizona
Arkansas
California
Colorado
District of Columbia
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kentucky
Louisiana
Maryland
Massachusetts
Michigan
Mississippi
Missouri
Nevada
New Hampshire
New Mexico
New York
Ohio
Oklahoma
Pennsylvania
Puerto Rico
Tennessee
Texas
Utah
Virginia
Please note that services are not currently available in the following states: AK, CT, KS, ME, MT, NE, NC, ND, OR, NJ, RI, SC, SD, VT, WA, WV, WI, WY
Excellent, now let's get some information about you.
Agent First Name
*
Agent Last Name
*
Agent Email
*
Agent Phone
*
Agent Code
*
Okay, now we just need your upline's information.
Manager First Name
*
Manager Last Name
*
Manager Email
*
Is there a Split Agent for this client?
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Yes
No
Split Agent First Name
*
Split Agent Last Name
*
Split Agent Code
*
Perfect. Let's get some information regarding your client.
Client First Name
*
Client Last Name
*
Client Email
*
Client Phone
*
Client Alt. Phone
Do you have your client's spouse information?
*
Yes
No
Spouse information can help close your lead or lead to future business!
Spouse First Name
*
Spouse Last Name
*
We're almost done! Let's see when and how we can help your client.
When would the best time to call be?
*
Morning
Afternoon
Evening
Approximately, how much debt does your client have?
*
0-9,999
+$10,000
+$20,000
+$30,000
+$40,000
+$50,000
+$60,000
+$70,000
+$80,000
+$90,000
+$100,000
Any additional information to add?
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