Enter your sales leads on this form:
FIRST NAME
If unknown, enter "Current"
*
LAST NAME
If unknown, enter "Resident"
*
10-DIGIT PHONE NUMBER
e.g. XXX-XXX-XXXX
EMAIL
ADDRESS
*
CITY
*
STATE
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
*
ZIP CODE
e.g. XXXXX
*
Country
United States
*
FUEL TYPE
Propane
Heating Oil
Gasoline
Diesel
Kerosene
HVAC
Electric
Other
*
ACCOUNT TYPE
Commercial
Residential
*
ENTERED BY
*
CSC Name
Adams
Albemarle
Albion
Alden
Anthem - Chester
Anthem - Conyers
Anthem - Easton
Anthem - Taunton
Anthem - Waterbury
Anthem - York
Asheboro
Asheville
Ashland
Ball Ground
Bath
Big Flats
Blairsville
Bradford
Bridgewater
Brunswick
Buchanan
Buckley
Caledonia
Calhoun
Cartersville
Chester
Conway
Cortland
CT North
CT South
Curtis
Dahlonega
Dallas
Dalton
Dansville
Delano
Denmark
Deposit
Douglas
Dover
East Greenville
Elkton
Ellijay
Exeter
Fairmount
Farmville
Florida
Franklinville
Gainesville
Griffin
Hallowell
Harrisburg
Hawley
Hi Grade
Hope Valley
Howard
Hudson Valley
Jesup
Kal Gas
Kenansville
Kennebunk
Lagrange
Lee
Littleton
Lodi
Lowville
Lumberton
Maple City
Marlboro
Methuen
Middlesex
Montoursville
Montville
Morganton
Mt Vernon
Murphy
Murrells Inlet
N Haverhill
Nahunta
Newark
Newnan
Norristown
Northbridge
Oak Ridge
Palmer
Pearl Creek
Perkasie
Phenix City
Plainfield
Plattsburgh
Port Henry
Potsdam
Propane Services
Ranger
Reading
Red Creek
Rhode Island
Rindge
Ringgold
Rome
Roy Bros
S Portland
Saratoga
Shamokin
Shelby
Skaneateles
Slatington
Southbridge
Spring Hope
Springvale
St Johnsville
Sterling
Stokes
Sunderland
Syracuse
Tallahassee
Troy
Vestal
Waldo
Warren
Watertown
Waterville
Waycross
Wayland
White Haven
Whiteville
Whitinsville
Winder
Windham
Wolcott
Woodhull
Woodstock
Wurtsboro
*
IMMEDIATE FOLLOW-UP
NOTES
Campaign ID
Lead List
Lead Source