Help Us Expand Our Reach!
You obviously believe that long-term care financing is a critical issue, as evidenced by your subscription to LTC Bullets. But just imagine: if you and all of our current LTC Bullet subscribers could refer names of potential subscribers, the goal of increasing our sphere of influence would become a reality.
Please complete the following information and return it to us at your earliest convenience. Print this form and either fax it (206-283-6536) or mail it (2212 Queen Anne Avenue, N. #110 Seattle, WA 98004) to us. Thanks again for helping accomplish our shared goal.
Sure, I’d like to help grow the number of LTC Bullet subscribers! Here are some names of individuals you may wish to contact regarding a subscription to LTC Bullets:
Referral #1
Name: ___________________________
Business affiliation (if applicable): ______________________________
E-mail address (Please try to provide us with an e-mail address, as this form of communication is preferred): _____________________________
Phone _______________________
Business address (if applicable, if not a home address may be provided):
_________________________________________________________
City _____________________ State ____________ Zip _______
_____ Yes, you can say I suggested the name.
No, I prefer to remain anonymous.
Comments:
Referral #2
Name: ___________________________
Business affiliation (if applicable): ______________________________
E-mail address (Please try to provide us with an e-mail address, as this form of communication is preferred): _____________________________
Phone _______________________
Business address (if applicable, if not a home address may be provided):
_________________________________________________________
City _____________________ State ____________ Zip _______
_____ Yes, you can say I suggested the name.
No, I prefer to remain anonymous.
Comments:
Referral #3
Name: ___________________________
Business affiliation (if applicable): ______________________________
E-mail address (Please try to provide us with an e-mail address, as this form of communication is preferred): _____________________________
Phone _______________________
Business address (if applicable, if not a home address may be provided):
_________________________________________________________
City _____________________ State ____________ Zip _______
_____ Yes, you can say I suggested the name.
No, I prefer to remain anonymous.
Comments:
Referral #4
Name: ___________________________
Business affiliation (if applicable): ______________________________
E-mail address (Please try to provide us with an e-mail address, as this form of communication is preferred): _____________________________
Phone _______________________
Business address (if applicable, if not a home address may be provided):
_________________________________________________________
City _____________________ State ____________ Zip _______
_____ Yes, you can say I suggested the name.
No, I prefer to remain anonymous.
Comments:
Referral #5
Name: ___________________________
Business affiliation (if applicable): ______________________________
E-mail address (Please try to provide us with an e-mail address, as this form of communication is preferred): _____________________________
Phone _______________________
Business address (if applicable, if not a home address may be provided):
_________________________________________________________
City _____________________ State ____________ Zip _______
_____ Yes, you can say I suggested the name.
No, I prefer to remain anonymous.
Comments: