---- Long Term Care Lead Sheet ----

TEL-AMERICA TELEMARKETING  |  PO Box 26, Franklin Square, NY 11010  |  Tel 516 437-4242  |  Fax 516 775-9413
 
MARRIED   
 
SINGLE   
 
YOUR AGENCY

Hello, this is____________, calling from Your Agency. How are you today? We are calling to follow-up on a letter we recently sent you regarding Long Term Care Insurance. What I would like to do is ask you a few quick questions so our Long Term Care Specialist can call you with a no obligation quote.

1. Are you aware that LTC Insurance protects your Legacy from any serious illness?
    ____YES   ____NO

2. Date of Birth: ______/______/______/.

3. How would you describe the condition of your health? ____EXCELLENT   ____GOOD

SPOKE TO:
_________
Mr./s.
 / _______________________________________________________
    First                                     Last

A representative of Your Agency will call you tomorrow.

BEST TIME TO CALL ________________________________________________________

Caller______________________________________Date____________________________

Call Date Representative NOTES