Sales Submission | Lighthouse 360 Canada

SUBMITTING A NEW LIGHTHOUSE CLIENT

Submitting your first sale is exciting! Here are the steps you need to take to make sure your client is setup for success and you receive credit for the sale:

Step 1: Fill out this Lighthouse Sales Form
Step 2: Have the practice sign in and accept the Lighthouse Customer Terms
Step 3: Lighthouse will contact your client to collect billing information for the setup fee during the date/time you suggest.

PARTNER SUBMISSION FORM

Partner Information
Partner Company Name*
Partner Rep. Name*
Contact Information
Practice Name*
Primary Contact First Name*
Primary Contact Last Name*
Phone*
Email*
Business Street Address*
Business Street Address 2
Business City*
Address*
Select a State Business Zip
General Information
Practice Management System*
Lighthouse Monthly Retail Fee*
Current Website
Install Contact Name*
Install Phone Number*
Best Day & Time to Contact for Setup Fee Collection*
Has your new client signed the Lighthouse Customer Terms yet?**
Additional Notes

SUBMITTING A NEW LIGHTHOUSE CLIENT

PARTNER SUBMISSION FORM

Partner Information

Contact Information

General Information