Assisted Living Leads

A QuickHealthInsurance Group, Inc. Company.

Not Affiliated With Any Broker or Agency.

Proud Sponsor of the largest Association of Agents

Questions to Visitors/Leads are HIPPA Compliant & Reviewed by Blue Chip Legal Team.

Free USA Zip DB [Ex. search term: zip tx]

For Agent Use only. Not For Distribution.

"This is a reliable lead source" - Steve V, General Agent

"Don't be confused by the name of the company - medigap leads are also good." - John M, Independent Agent

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Our assisted living leads are eager to talk to you, because they are NOT bombarded with phone calls. We strive to send you quality leads so that you can be more effective.

Did your leads stop answering your phone calls?

Most of the asssited living lead companies may send the same lead to too many places. This results in unhappy customers getting phone calls from multiple places. As a result, they stop answering phone calls- even though you may have the best solution for them.

Our leads are eager to talk to you because you are the only one representing the product. Our lead does not go to another assisted living place with the same services. We are sure you will be happy with this sustainable win/win customer friendly solution. However, this advantage comes for a price- we cannot accommodate everyone. Please reserve your territory before someone else does. For enquiries, please, call 1-800-959-9247.

You must fill in the enrollment form below to become an active member of our pay per lead program. Upon completion and if available, you will receive leads from your selected territory immediately. After a visitor from your selected territory completes a quote request form, that lead will be sent to your e-mail. You can limit how many leads you want per week.

For a limited time, there are no setup fees and no deposits required. Leads are priced at $49 each. We strive to send you quality leads so that you can be more effective.

Fields in red are required

Assisted Living Company:
Contact Name:
Cell Phone Number:	( )
Cell Phone Provider (ex: T-Mobile):
Fax Number:
E-mail [Must provide 2 Addresses. Ex: i@yahoo.com, me@hotmail.com]:
Address:

City:
State:
[Credit Card Billing] Zip Code:

Licensing Information:

Please list the States in which you are licensed to practice.

Lawyer Services: Leads

LINE OF BUSINESS SELECTION (required)

Click on the select box for the type of leads that you wish to receive for each of the zip codes that you enter below.

You must choose at least one line of coverage and a minimum of one 3 digit SCF zip code [Example: 750**] .

Assisted Living
Other Leads [Explain your need below]
Appointment Settings - Followup Calls

ZIP CODE SELECTION (Required. You must select one 3-digit zip code (Example: 931) or at least 15, 5-digits zip codes (example: 93102).)

Please type the zip codes that you would like to reserve in the boxes below. This page allows you to select your first 30 zip codes. If you would like a larger number of zip codes (for example: a County, Area Code, or State) please make a note in the comment box below. Include the territory that you would like.

This will assist you in making your selection.

Enter the zip codes you wish to reserve.

Additional Territory Request: (please add any additional territory requests here. For example, if you would like a larger territory than you listed above, simply list the County, area code, or State that you would like to reserve and we will take care of the rest. You can even give us a radius (in miles) around a zip code and we will insert all zip codes within the number of miles you request.)

CREDIT CARD ENTRY (required)

Please enter your credit card information to complete your membership. This is a secure page.

Please note:

We do not charge either maintenance or monthly fees.
Your credit information is kept offline in our transaction system (it is not in an online database).
You will receive an e-mail invoice once your balance reaches $50.
We will charge your credit card after sending the invoice.

Credit card type
Expiration date
Name on card
Credit Card Number
Please note: We do not database your credit card number, your credit information is kept offline in our transaction system. If you have any questions, or concerns, regarding the security of the payment process please contact Leads
CVV (Visa and Mastercard)	(Your credit card has a 3-digit security code found on the back of your card, listed after your credit card number in the signature area. We request you enter this number as an added security measure.)

By submitting your information to quickhealthinsurance.com, you agree to the above terms along with the quickhealthinsurance.com TERMS OF SERVICE as outlined HERE

IN ORDER TO CONTINUE, YOU MUST AGREE TO THE TERMS OF SERVICE as outlined HERE BY TYPING
"I agree" in the following box:

AGREEMENT:

Please list any additional comments:

Before submitting, please, print this page using the print command from the file menu at the top left corner of this page, sign and fax it to (206)-350-4739 as soon as you can. You may not receive leads until we receive the fax. Don't forget to click the following button to start getting leads as early as tomorrow morning.