| 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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