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ProducersWEB.com Staff
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First Name
Last Name
Company Name
Address
City
State
Zip / Postal Code
Phone
Fax
Email
1. Which of the following best describes your title?
(Check all that apply)
Life Insurance Agent
Health Insurance Agent
Property and Casualty Agent
Financial Planner
Registered Investment Advisor (RIA)
Sales Management/Wholesaler
Accountant/CPA
Attorney
President/CEO/Principal
None of the above
2. The markets I currently/plan to target include:
Current Markets
Senior Market
Affluent Market
Baby Boomer Market
Business Market
College Funding Market
Family Funding Market
Group/Voluntary Benefits Market
Planned Markets
Senior Market
Affluent Market
Baby Boomer Market
Business Market
College Funding Market
Family Funding Market
Group/Voluntary Benefits Market
3. I am involved in selling the following:
(check all that apply)
Annuities
Equity Index Annuities
Immediate Annuities
Multi-Year Guarantee Annuities
Structured Settlements
Traditional Fixed Annuities
Tax Sheltered Annuities
Variable Annuities
Charitable Gift Annuities
Long Term Care and Medicare/Other
Individual LTC
Group LTC
Substandard LTC
Tax Qualified LTC
Medicare Supplements
Critical Illness Insurance
Disability Insurance
Group Disability
Individual Disability
Life Settlements
Investments
Life Insurance Buying
Viaticals
Life Insurance
Accelerated Death Benefit
Annuity Take Over
First to Die
Final Expense
Guaranteed Issue
Impaired Risk
No Load Insurance
Second to Die
Single Premium Life Insurance
Term Insurance
Universal Life
Whole Life
Variable Life
Securities
Bonds
Limited Partnership
Mutual Funds
Stocks
Variable Annuities
Variable Universal Life
Voluntary/Group Benefits
Voluntary Benefits (LTCI, Auto, Home, Legal, Gap, Accident, Cancer, Discount)
Core Benefits (Basic Life, Disability, Medical, Flexible Spending)
Health Benefits (Medical, Dental, Vision, Flexible Spending)
Life Benefits (Basic Life, AD&D, Voluntary Life, Travel Accident)
Retirement Savings Plans (401K, Deferred Compensation)
None of the Above Products
4. My Income is
5. Number of agents in my organization
6. I have been involved in selling
Insurance
Under 3 Years
3 - 10 Years
11 - 20 Years
Over 20 Years
Not involved in selling
Securities
Under 3 Years
3 - 10 Years
11 - 20 Years
Over 20 Years
Not involved in selling
7. I am
8. I am a member of
(check all that apply)
FPA
LUTCF
MDRT
NAHU
NAILBA
NAIFA
NAELA
NAPFA
SFSP
None of the Above
9. Licenses and Designations (currently hold, or working towards)
(check all that apply)
CSA
CLU
ChFC
CEP
CFP
RHU
CPCU
CPA
RIA
Series 6
Series 7
CLTC
LTCP
None of the Above
10. I plan to hire a Coach to help me with my practice
Within the next 3 months
Within the next 12 months
Within the next 3 years
I do not plan to hire a coach
11. Areas of Interest
(check all that apply)
Business Development
Career Guidance
Help/advice getting to the next levels
Marketing
Maintaining Focus, Drive and Motivation
Personal Development
Personal Life-style enhancement
Practice Management
Product Knowledge
Prospecting techniques
Referrals
Sales Strategies
Team Building
Templates for successful business development
None of the above
12. Which ProducersWEB.com e-Newsletters would you like to receive?
ProducersLIFE Weekly e-Magazine (www.producerslife.com)
Daily Special Offers (www.proweboffers.com)
Weekly Update: Most Popular (www.producersnews.com)
Sales Circle Monthly (www.prosalescircle.com)
Senior Market Circle Monthly (www.seniormarketcircle.com)
Annuity Circle Monthly (www.annuitycircle.com)
Insurance Circle Monthly (www.insurancecircle.com)
Monthly Media Message (www.ProMediaMessage.com)
13. Are there any comments you would like to pass along to the ProducersWEB Team?