< Back to Team Services Member Prep Sheet Step 1 of 7 14% Owner InformationInformation about the owner of the insurance policy.Owner Name First Last Owner Email* Owner Phone NumberTimezone of the OwnerEasternCentralMountainWesternAlaskaHawaii Insured InformationInformation about the insured body of the insurance policy.Is the person being insured the same as the Owner? Yes Insured Name First Last Insured Email* Insured Phone NumberInsured GenderChoose GenderMaleFemaleState of Residence of InsuredEnter state of residence of insured personAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificInsured Date of Birth MM slash DD slash YYYY Policy DetailsInsurance Company to be usedSelect the insurance companyAmerican United Life Insurance CompanyAmeritas Life Insurance Corp.Lafayette LifePenn MutualSecurity Mutual Life Insurance Company of New YorkThe Ohio National Life Insurance CompanyMass MutualReferred ByChoose the person who referred this memberBrandon OutlawBrent KeslerChris NaugleGabby DarrochGabe RetanaHannah KeslerJake KevorkianJay AndrusJeremiah DewJonah DewJoshua ZieglowskyKathy ScalzoKeith HatchettMara ReamMichelle HumphreySandra FrySot ElStephen NagySue ZavelleSulaman HemaniWorkshop Attendee (Y/N)Select Y/NYesNoWorkshop InformationPremium Mode (Monthly, Qtr, yr)Select Premium FrequencyMonthlyQuarterlySemi-AnnualYearlyPremium Amount Commission Structure and PartnersHow many people are part of this commission?Select the amount of people involved with the comission12345678910Commission Owner 1 Commission Owner 1 % Commission Owner 2 Commission Owner 2 % Commission Owner 3 Commission Owner 3 % Commission Owner 4 Commission Owner 4 % Commission Owner 5 Commission Owner 5 % Commission Owner 6 Commission Owner 6 % Commission Owner 7 Commission Owner 7 % Commission Owner 8 Commission Owner 8 % Commission Owner 9 Commission Owner 9 % Commission Owner 10 Commission Owner 10 % HiddenTotal PercentageError! The total percentage is OVER 100%! This must be changed in order to continue.Error! The total percentage is UNDER 100%! This must be changed in order to continue.The total percentage = 100%!You must enter in commission owners and commission owner percentages to continue. Illustration AttachmentPlease attach the illustration if available.Attach IllustrationAccepted file types: jpg, gif, png, pdf, Max. file size: 10 MB. Select Application SpecialistSelect who you want to own this policy opportunity.Application Specialist*Select an Application SpecialistBonnie LorantyDavid TurishDustin DavisHannah KeslerJo SundermeyerJohn ClarkMiranda DavisSandra FrySara TaylorRound RobinAdditional Notes? Yes Additional Notes Select Mapping SpecialistSelect a mapping specialist for the policy ownerMapping Specialist*Select a Mapping SpecialistJonah DewAndrew ChesnuttRobby PeedJerome MarquardtTerri KeslerRound Robin Δ
