1. Address
1.1. Street
1.2. City
1.3. State
1.3.1. Billing Address
1.3.1.1. Street
1.3.1.2. City
1.3.1.3. State
1.3.1.4. Zip Code
1.3.1.5. Country
1.4. Zip Code
1.5. Country
2. Lead Contact
2.1. Phone
2.2. Mobile
2.3. Fax
2.4. Office
2.5. Ext.
2.6. Email
2.7. Website
2.8. Years in business
2.9. Description
3. Lead
3.1. Company
3.2. First Nane
3.3. Last Name
3.4. Title
3.5. Medical Plan Year
3.6. Benefits Review Timeframe
3.7. No. EE
3.8. Lead Status
3.8.1. New
3.8.2. Called
3.8.3. Meeting
3.8.4. Call Back
3.9. Origin
3.9.1. Phone
3.9.2. Drop
3.9.3. Referral
4. Solutions
4.1. Coverage Interest Picklist
4.1.1. Major Medical
4.1.1.1. RAF
4.1.2. GAP
4.1.3. Vision
4.1.4. Dental
4.1.5. Disability
4.1.6. Chiro/ Accu
4.1.7. EAP
4.1.8. Voluntay
4.1.8.1. Accident
4.1.8.2. Cancer
4.1.8.3. CI
4.1.8.4. Hospital
4.1.8.5. Sickness
4.1.8.6. Vision
4.1.8.7. Dental
4.2. Health Connect HR
4.2.1. Base System
4.2.2. POP Plan
4.2.3. Payroll
4.2.4. HR Answerlink
4.2.5. EAP
4.2.6. FSA
4.2.7. FSA Debit Card
5. Auxiliary Coverage
5.1. Dental
5.1.1. Dental Carrier
5.1.1.1. Dental plan 1
5.1.1.1.1. Premium
5.1.2. Dental Carrier 2
5.1.2.1. Dental plan 2
5.1.2.1.1. Premium
5.2. Vision
5.2.1. Vision Carrier
5.2.1.1. Vision Plan
5.2.1.1.1. Premium
5.2.2. Vision plan 2
5.2.2.1. Plan 2
5.2.2.1.1. Premium2
5.2.3. Premium total
5.3. Voluntary Picklist
5.3.1. Accident
5.3.2. Hospital
5.3.3. CAncer
5.3.4. CI
5.3.4.1. Premium Total Monhtly
5.3.4.1.1. Annually
5.3.5. Dental
5.3.6. Sickness
5.3.7. Vision
5.4. Life ins
5.4.1. Life Carrier
5.4.1.1. Life Plan
5.4.1.1.1. Premium
5.4.2. Carrier
5.4.2.1. Life2
5.4.2.1.1. Premium
5.4.3. Notes
5.4.3.1. Premium total
5.5. Auxiliary Plans
5.5.1. EAP carrier
5.5.1.1. EAP Policy
5.5.1.1.1. Premium
5.5.2. Chiropractic
5.5.2.1. Chiro Accupunture
5.5.2.1.1. Premium
5.5.3. Disability Carrier
5.5.3.1. Disability plan
5.5.3.1.1. Premium
5.5.4. Premium total
5.6. Premium totals
5.6.1. Monthly Total
5.6.1.1. Annual Total
5.6.1.1.1. Notes
6. Policy Info
6.1. Plan Year
6.2. Carrier 1
6.2.1. Policy
6.2.1.1. Premium
6.3. Carrier 2
6.3.1. Policy 2
6.3.1.1. Premium3
6.4. Carrier 3
6.4.1. Policy 3
6.4.1.1. Premium
6.5. Monthly Total
6.5.1. Annual Total
6.6. Notes
6.6.1. Satisfaction Level
6.6.1.1. Goals for new years benefits