RRMI CPA
Caller Number
*
Zip Code
*
First Name
Last Name
Email Address
Address
City
State
Date of Birth
Insured
Select any
Yes
No
Both
Lead Generated UTC
Special high risk insurance
Select any
Yes
No
Basic Coverage
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Yes
No
Current Insurance provider
Vehicle Count
Home Ownership
Select any
Yes
No
Jornaya Lead ID
Trusted Form Certificate ID
Optin
Select any
Yes
No
Both
Optin Language
TCPA Call Consent
Select any
Yes
No
TCPA Text
TCPA URL
Transfer Type
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Inbound
Outbound
Submit