Tax Recovery USA Form

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This Form cannot be submitted until the missing
fields (labelled below in red) have been filled in

Yes! Tell me more about Tax Recovery USA: The Ultimate Insurance Selling System!

Please note that all fields followed by an asterisk must be filled in.

First Name*

Last Name*

E-Mail Address*

Street Address*

City*

State/Prov*

Zip/Postal Code*

Home Phone

Business Phone*

Fax

Have you sold Fixed Annuities before?*

	No, never
	I've sold some
	I'm a solid producer

How soon can you submit a piece of business?*

	I have no prospects now
	I have a case to submit now
	I have a few warm prospects

If you have business to submit now, is it:

	Over $50,000
	Under $50,000

Comments:

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