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DRG Foundation
 
By completing the form below and providing us with detailed information about your practice, DRG will have a better understanding of your business and will allow us to provide you with more customized service and support. As part of our Advanced Track initiative, we can also help you explore marketing opportunities within your practice and other areas that you could investigate.

* denotes required fields.


*Who is your DRG Representative?
*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?
Yes No

Preferred method of communication Phone Email
Address
City State     Postal Code
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?
Life DI Health LTC Financial / P&C / Annuity None
Regarding Individual Plans, what industries do you focus on?
Blue collar Grey collar White collar Professionals Retirees Business owners

What type(s) of Group Coverage Plans do you currently offer?
Health Life STD LTD 401K Vision/Dental None
Regarding Group Plans, what Industries do you focus on?
Municipalities Professionals Manufacturing Technical / Computer General Business
Average Size of Groups?
Approximately how many groups do you service?

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






 

 

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