PPL Small Business Plans
Member Information Sheet
Activity / Follow-up Log
Business Name ________________________________   Date Membership Sold:__________
Membership # ________________________________________________

Address _____________________________________________________

City _____________________________  State ______  Zip ____________

Phone ___________________________  Fax _______________________
Email _______________________________________________________
Principal Contact ______________________________________________
# of Employees ___________
7 - 10 day Follow-up Meeting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . .Date:__________ 

Comments:

Referrals Given (Names)      __________________  ___________________ ________________

 

                                                 __________________  ____________________  ________________

Group Plan Presentation  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  Date:__________

30 day Follow-up Phone Call . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . .Date:__________

Comments:
Referrals Given  ___________________  _______________________  ___________________

3-6 month Follow-up Meeting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . . . . . . . Date:__________

Comments:
Testimonial Letter Received _________________
Referrals Given (Names) __________________  ____________________  ________________


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