D2D Lead Entry
Lead Entered By:
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Appointment Setter:
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First Name
*
Last Name
*
Address
*
City
*
State
*
Postal code
*
Phone
Email
Do you own your home?
*
Yes, I own my home
No, I rent my home
Credit Score Above 650?
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Roof Type
Select type of roof
Utility Company
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Average Monthly Bill
Promo Code (if applicable)
Comments
Marketing Permissions
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