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Agent Lead Request Form
Program Requirements:  Jack Schroeder and Associates’ Turning 65/72 lead program is offered at no cost.  To participate, agents must be appointed with at least 2 of JSA’s senior market carriers and have an email address.

Program Guidelines:  Prospect lists will be distributed 4 months in advance of the prospects’ 65th, or 72nd birthdays.  Agents may select a combination of up to 5 Zip Code, or County areas.  Every other month, JSA will email a prospect list based on the specifications requested below.  JSA reserves the right to discontinue this program at any time.
Name:
Agency:
Address:
City, St & Zip:
Phone Number:
Email Address:
 

 



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