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Full Name

Phone *

Email *

Business Name (if any)

1. How long have you been in the insurance/financial services business?

Under 1 Year

1–3 years

3–7 years

7–15 years

15+ years

2. What licenses do you currently hold? (Check all that apply)

Life

Health

Series 6/63

Series 65/66

Series 7

RIA affiliation

P&C

None yet

3. What’s your “bread & butter” product? (main product focus)

Final Expense

Term Insurance (Mortgage Protection)

Whole Life

GUL / UL / IUL / VUL

Disability Insurance

Long-Term Care

Annuities

4. Are you currently captive or independent?

Captive (Guardian, NYL, Northwestern Mutual, etc.)

Independent (multiple carriers, IMO/BGA)

5. Who is your primary upline, IMO, BGA, or Broker Dealer (if applicable)?

6. Do you currently have a website?

Yes

In progress

Website

7. Do you use social media for business purposes? (Select all that apply)

Facebook

YouTube

Instagram

TikTok

Not currently using social media

8. Do you currently use a VSL funnel (Video Sales Letter) or YouTube videos to attract clients?

Yes, I use a VSL funnel

Yes, I use YouTube videos

Yes, I use both

No, but I’d like to explore this option

No, and I’m not interested

9. Do you currently use a CRM system?

Yes – which one?

10. Do you have any automated marketing or nurturing campaigns set up?

Yes

Not sure

11. What tools or platforms do you use regularly for your business? (Select all that apply)

GoHighLevel

Calendly / scheduling tool

Email marketing software

Financial planning/illustration software

eApp platforms

None yet

12. What’s the biggest bottleneck in your business right now?

13.Which of the following do you want help with most? (Choose up to 3) *

More qualified leads

Clear marketing strategy

Better branding/online presence

Improved client onboarding

Referral growth

Systems and automation

Sales process scripting

KPI tracking and business metrics

14. Would you like to be considered for ongoing coaching through the Elevate Your Business™ Program?

Yes – I’d love to grow

Maybe – tell me more

Not right now