Simplicity Group Referral Form

Referring Party Information:

Your First and Last Name

Simplicity Organization

Phone Number

Your Email Address

Rep Referral Information:

First and Last Name

Company

Phone

Email Address

Would you like us to talk about the broker-dealer (Leaders Group)?
YesNo

Prospect is a Simplicity Wealth candidate?
YesNo

How would you like us to reach out to this referral?
PhoneEmail

Would you like to be copied on correspondence?
YesNo

Anything we should know regarding this relationship:

Δ