Turn your dead leads into cash
Franchise Lead Submission Form
Fields in RED should contain YOUR INFORMATION (NOT the Referral's)
	Your FULL Name
	Company Name
	Address
	City and State
	Zip
	eMail
	Phone
	May we use your name when Contacting your referral	Yes No
	Referral Name
	Referral Address
	ReferralCity
	Referral State
	Referral Zip
	Referral eMail
	Referral Phone
	Referral Cell Phone
	What franchise concept were you promoting to this prospect
	Why were you unable to sell this prospect a franchise
	Are there any hot buttons or comments you would like us to know about this prospect
	How much liquid capital did the candidate have available to invest	$5,000 - $9,999 $10,000 - $19,999 $20,000 - $29,999 $30,000 - $39,999 $40,000 - $49,999 $50,000 - $59,999 $60,000 - $69,999 $70,000 - $79,999 $80,000 - $89,999 $90,000 - $99,000 $100k - $250k Above $250k
	Referrals Net Worth	Under $100,000 Under $250,000 Under $500,00 Under $750,000 Under $1,000,000 Over 1 Milliion
	Referrals Time Frame to invest	0 - 3 Months 3 - 6 Months Unknown
	What is the Referrals current profession
	What is the best time to reach this person	Anytime Morning Afternoon Evening
	Do you want this referral source kept strictly confidential	Yes Ok to use my Name
	Comments