REVOLUTION MEDIA, LLC

Website Ordering

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Please Note: This form includes required fields, meaning you will not be able to click submit if any information is missing. If at any point you’d like to save your progress and return later, simply scroll to the bottom of the form and click the ‘Save and Resume Later’ link.

Your Company & Agent Information:

What is the legal name of your entity/company? *

Agent Name *

First

Last

Agent Email *

Agent Mobile Phone Number *

Company Address *

Address Line 1

Address Line 2

City

State

Zip Code

Upload Logo *

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

Additional Staff

Phone number you would like listed for all marketing materials *

Email you would like listed for all marketing materials and where form leads will be sent? *

What is your License number as well as the business' license number? We need all license numbers for the disclaimer that is in the footer of the website as well as any marketing material we create for you. *

Please provide any disclaimers you use. *

Please upload a copy of your department of insurance license certificate. *

Drag & Drop Files, Choose Files to Upload

Do you own your URL? If so, please provide the login and password for your domain name (such as a GoDaddy Login). *

Who is your Email Provider? (For example, Gmail, Office 365, Outlook, AOL, Yahoo, etc.) *

Who are you using for Email Marketing (Mailchimp, Bomb Bomb, Constant Contact, etc)? (We are a partner with Constant Contact and can offer discounts and set up.) *

Please provide the usernames and passwords for all Email Marketing services: *

Who do you use for Text Marketing services? Texting will increase your response rate by 30-40%. If you aren't already with a texting platform, and we recommend Skipio *

If you would like any specific images used for photography, please upload them here

Drag & Drop Files, Choose Files to Upload You can upload up to 20 files.

Are you interested in Social Media posting, Weekly Tips, or Blog/News postings? *

Are you interested in any additional Graphic Design services, such as Banners, Business Cards, Logo Design, etc? *

Please list any additional services/products you sell besides Annuities and IULs if you would like those included (such as wealth management, medicare, health insurance, etc.)

List all Charities that you contribute to

Upload Charity logos, if you have them.

Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.

Website Ordering:

Who should we correspond with about this job? *

First

Last

Email *

Phone *

Which package are you ordering? (view details of each package below) *

Cookie Cutter Package $1,000
Mid-Level Package $4,500
High Level Package $6,500

Billing:

Should we bill the Revolution directly and use seminar credits? Please note that the Revolution pays IMMEDIATELY, so if you would like to review the invoice first, select NO. Once billing is set up this way, the Revolution will be billed EVERY TIME until you tell us otherwise. *

I acknowledge that payment is due within 30 days of receipt of the invoice. After 90 days of non-payment, a penalty of 10% interest, accrued monthly, will incur. After 180 days, Revolution Media will cease to conduct business with me and may report the debt to a collection agency. *

I acknowledge that payment is due within 30 days of receipt of the invoice. After 90 days of non-payment, a penalty of 10% interest, accrued monthly, will incur. After 180 days, Revolution Media will cease to conduct business with me and may report the debt to a collection agency.

Signature *

Clear Signature

Website

Save and Resume Later

($2400 Value!)

Cookie Cutter

*Needed for Webinars & Digital Marketing

Includes:

Pricing:

Services Not Included But Available For Extra Charge:

($6500 Value!)

Mid-Level

Includes:

6-9 Page Custom Website (Home, Annuities, Life Insurance, Retirement Strategies, Contact, About, 3 Principles)
SEO: Google / Yoast / Best Practices Copywriting
Assistance Repointing Domain Name
Interviews: What Makes You Unique? Includes Interviews & Copywriting for Bios

Pricing:

Services Not Included But Available For Extra Charge:

Logo Design Or Logo Rework $150 - $350
Assistance With Email Setup / Transfer: $135 Per Hour
Blog Posting of E-Newsletter / $135 Per Hour
Access To Account Logins (Allianz, American Equity Etc.)
Client Portal & Leave A Review Page
Seminar Registration / Client Events Calendar

($8500 Value!)

High Level

Includes:

10-16 Page Custom Website - More Pages = More SEO + More Opportunity for Organic Traffic
SEO: Google / Yoast / Best Practices Copywriting
Assistance Repointing Domain Name
Interviews: What Makes You Unique? Includes Interviews & Copywriting for Bios