Crossfield Strategic Partners

Agent Intake Form

This intake form is designed to help us better understand your background, experience, and goals so we can determine the best way to support your success. Please complete the information below as accurately as possible—our team will use this to guide your onboarding process and align you with the right systems, training, and opportunities within Crossfield.

Legal First Name *

Legal Last Name *

Email *

Phone *

Date of birth *

Address

Street Address

City

State

Country

Country

Postal Code

Are you currently licensed? *

License Type(s)

Resident State

Non-Resident States (if applicable)

License Number

If not licensed, when do you plan to test?

Do you need licensing support? *

Have you worked in financial services before? *

Years of Experience *

Previous Company / IMO (if any)

What products have you sold? *

Approximate Annual Production (if experienced):

Current Business Model: *

What are you looking to build? *

Income Goal (Next 12 Months): *

How many hours per week can you commit? *

Are you interested in working with affluent / high-net-worth clients? *

How did you hear about us? *

If referral, who referred you to us?

Tomer

Dawn

Vivian

Robert

Caleb

Alberto

Why are you interested in joining Crossfield? *

What would make this opportunity a success for you? *

Are you ready to begin onboarding within the next 7 days? *

I understand this is a commission-based opportunity *

Yes

I understand licensing is required prior to selling *

Yes

I agree to complete required training and compliance requirements *

Yes