*Who is your DRG Representative? - Benjamin Perez Bryan Orr David A. Saltzman Jeff Tabor Jim Brown John Nichols Joseph McCracken Kevin Cloutier Mose Richardson, Jr. Rick Fitzke I'm not sure
*First Name *Last Name
*Email Address
*Business Phone Cell Phone
*Do we have your permission to use email as one of our methods of communicating with you from here forward?
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Preferred method of communication Phone Email
Address
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Key Employee or Contact?
Key Contact PhoneKey Contact Email
Association Memberships? NAIFA NAHU SFSP MDRT Other
How did you hear about DRG?
At an event or function Speaking engagement Referral from fellow advisor
Referral from an industry professional Search engine / internet DRG Representative
Other
Do you have an Agency or Broker/Dealer Affiliation? With Whom:

Practice Specialty or Focus

What type(s) of Individual Coverage Plans do you currently offer?

What type(s) of Group Coverage Plans do you currently offer?
Regarding your last D.I. case, who helped you?
Direct Carrier Contact Disability Resource Group
A different brokerage agency, please list name:

Describe your most common obstacles to making DI sales:
Customer understanding the value Underwriting issues Product knowledge
Lack of operational support Pricing Benefits

Professional Preferences

Regarding your practice, what would you prefer to be spending your time on?
Sales Prospecting Networking Problem Solving Case Design
Customer Contact Practice Management More free time

What do you like to do least in your practice?
Application Processing Following-up with Underwriting Business Operations
Prospecting Case Design Sales Networking

We are connected to true business growth experts and we can send you their articles, tips and ideas for free.
Which type(s) of information would you like to receive (check all that apply):
Entrepreneurship Leadership / Management Sales Marketing
Customer Service Communications Skills Personal Development

If we could show you how to leverage your business with our capabilities to help improve your business would you be interested?
Yes No