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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:
Toll free: (800) 582-5721
Local: (920) 884-3200
Contact JSA
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