Legacy Financial CRM Subscription Intake Form

Basic Information

Do you want to use the AUTOMATED Text and email follow-up systems that we have built up for you? It pushes the leads to book and appointment with you. *

Yes

Maybe Later

Please add your availability hours below for the days of the week so that the leads can self-book on your agent verifier page *

Legal Business Name (Use your name if you don't have one) *

Business Email *

Business Phone *

Business Website

Business Physical Address

Street Address *

City *

State *

Country *

Postal Code

What is your Timezone? *

Business Information

For A2P Compliance

Is your Business Registered *

ALERT: If you hit Yes, We will need EIN FORM

EIN Form Details

Enter your 9- digits EIN here (enter "none" if you don't have it)

Upload Your EIN Form (CP-575 Form) - (click "next" if you don't have it)

PDF, PNG, JPEG, JPG, DOCX or DOC

EIN Form (CP - 575) Sample

Authorized Representative

First Name *

Last Name *

Phone *

Email *

Agent National Producer Number (NPN) *

Agent Photo

JPEG, JPG or PNG ( max 99 Files )