Affluence Legacy Group Intake Survey

Basic Information

Please Note, We are offering Vet and IUL Lead Drips in our System

Do you want to use the AUTOMATED Text and email follow-up systems that we have built up for you? It pushes the leads to book an appointment with you. *

Yes

Maybe Later

A2P Registration &amp;amp; Phone number setup Permission *

I allow Affluence Legacy Group to setup a Phone number and apply for its A2P registration knowing all the charges and fee that will be charged in this process completely.

The emails, calls, and texts sent out through the Affluence Legacy Group system will be charged separately as you go.
The breakdown of these charges is given below:

$ 0.0095 / SMS segment
$0.00135/ email
595 outgoing Calls for $10
980 incoming Calls for $10
1055 SMS segments for $10
7400 emails for $10
We will set up your phone number registration with LC Phone System that can take 2-3 days, or sometimes 5-7 days, and then your texts will start to go out. Moreover, you will be charged $1.23 to $2.37 separately for the Phone number that is assigned to you by LC Phone System

Please add your availability hours below for the days of the week so that the leads can self-book on your agent verifier page *

General Information

Legal Business Name (Use your name if you don't have one)

Business Email *

Business Phone *

Business Website

Business Niche *

Business Physical Address

Street Address *

must be a valid US address link to your business

City *

Postal/Zip Code *

State / Prov / Region *

Country *

What is your Timezone? *

Business Information

For A2P Compliance

Business Type *

Business Industry *

Is your Business Registered *

Business Registration ID Type *

Enter your 9- digits EIN here (enter "none" if you don't have it) *

Upload Your EIN Form (CP-575 Form)

We need this to set up your account accordingly

EIN Form (CP - 575) Sample

Authorized Representative

First Name *

Last Name *

Representative Email *

Write a few lines about you (bio on your Website)

Phone Number (With Country Code) *

Job Position *

Your (Agent's) National Producer Number (NPN) *

Upload Your Photo for the Agent Verifier Link (circular preferred) *

We need this to set up your account accordingly

Upload Your Logo(s)

We need this to set up your account accordingly

Affluence Legacy Group Intake Survey

Basic Information

General Information

Business Physical Address

Business Information

For A2P Compliance

Authorized Representative

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