HomeTech Supporttrade leadsmailing listbuy / sell leads
Welcome to LeadExchange
How to use LeadExchangeTradingRoom FloorHow to beginSign Up NowAbout usTerms of useJob OpportunitiesPress ReleasesTestimonials

Member Name:

Password:

With LeadExchange™ working for you, you'll have confidence that the leads that your web site produces are only from interested consumers.  Below you'll find a sample Group Health Insurance lead.  All consumers are required to fill out a standardized questionnaire in order to be considered a valid lead.  To return, please click here

Today, with health care costs rising dramatically each year, even relatively simple medical procedures can run into the thousands of dollars.

However, it is not just the cost of medical care that is rising. The variety of care available is also increasing.

In order to reduce the risk of unexpected health care costs, private health insurance companies now offer an array of health insurance programs and plans, that vary widely in terms of coverage, costs and benefits

Instructions:  Please fill in this form as completely as possible in order to ensure that your quote will be as accurate as possible.

First Name

 

Last Name

 

Street Address

 

City

 

State

 

Zip Code

 

Day Phone

 

Evening Phone

 

E-mail Address

 

Your Birthday (mm/dd/yy)

  19

Best time to call:

 

Employee / Family Member 1

Employee Name

M/F

Age

Status

 

 

 

 

Occupation

Salary

Currently Insured?

Plan type

 

$

 

 

Employee / Family Member 2

Employee Name

M/F

Age

Status

 

 

 

 

Occupation

Salary

Currently Insured?

Plan type

 

$

 

 

Employee / Family Member 3

Employee Name

M/F

Age

Status

 

 

 

 

Occupation

Salary

Currently Insured?

Plan type

 

$

 

 

Employee / Family Member 4

Employee Name

M/F

Age

Status

 

 

 

 

Occupation

Salary

Currently Insured?

Plan type

 

$

 

 

Employee / Family Member 5

Employee Name

M/F

Age

Status

 

 

 

 

Occupation

Salary

Currently Insured?

Plan type

 

$

 

 

Would you like an additional quote for any of the following insurance products?

 Life Insurance
 Annuities (Retirement Vehicle)
 Disability Insurance
 Long Term Care Insurance
 Health Insurance
 Auto Insurance
 Homeowners Insurance
 Home Loans

 

LEGAL  |  HELP

CONTACT US