Partnership Request First name* Last name* Email* Phone*Company name* Company registration number* Company registered office address* Company website* What referral types are you initially interested in (select all that apply)?* Life Insurance Health Insurance (private) Health Insurance (corporate) Income Protection Equity Release Mortgages Loans Are you authorised by the FCA?* Yes No What type of FCA authorisation do you have?* Directly Authorised Appointed Representative (AR) Introducer Appointed Representative (IAR) FCA authorisation number* Data protection registration number* Do you work with insurance or credit providers directly, or through a network?* Direct Network (Sesame etc.) Combination Which network and plan/panel do you use, for instance Sesame Zenith?* Do you have dedicated outbound call agents to work on your referrals?* Yes No How many outbound call agents do you have?* 1-3 4-9 10-19 20-39 40-69 70-99 100+ How would you like to receive your referrals?* CRM/API Email initially then CRM/API Which CRM/API do you use?* Bespoke FLG Lunar CRM Salesforce Connex One Zoho Other Which network do you use?* None - Own product None - Work direct with product providers Sesame Tenet Right Mortgage & Protection PRIMIS Mortgage Advice Bureau Other Name of network used?* CAPTCHA Address Visionary Markets Ltd, Maghull Business Centre, 1 Liverpool Road North, Maghull, Merseyside, L31 2HB Email info@visionarymarkets .com Phone Number Office: 01704 369 886Freephone: 0800 211 8614
