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AEP CoOp Form

We can’t wait to hear your idea to grow your business! Fill out the fields below and we’ll be in touch soon.

EXAMPLE: X leads generated, Y attendance to event, Z lead close rate/number of apps generated.
EXAMPLE: Agent will order 125 Medicare Supplement T-65 leads from XYZ Leads over 10 weeks costing $25/lead in St. Louis County, MO. Since the leads cost $25 x 125 leads ordered = $3125 in total lead spend.
EXAMPLE: I will follow up a minimum of 7 times per lead via phone and email.
EXAMPLE: The goal is to close 20% of the leads which will result in 25 sales with products through Senior Marketing Specialists.

Please submit your marketing plan along with an up-to-date W9 with your request.

Click here for a blank W9.

Please submit an up-to-date W9 with your request.

Click here for a blank W9.

Maximum upload size: 516MB
Maximum upload size: 516MB
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Disclaimer: agents must be certified and ready-to-sell with us before participating in this program.