• LEGACY Financial Life Professional Contact Information

  • Contact Information

  • This is the information that our service providers will use to contact the client

  • Please make sure to fill-out all required fields. Put N/A if not applicable.
  • Client Real Estate Details

  • Client Personal Wealth Details

  • Select the product/service(s) your client wants more information about from a licenced agent/provider such as an EMD (Exempt Market Dealer):

  •   REIT (Real Estate Investment Trust)

  •   MIC (Mortgage Investment Corporation)

  •   Mortgage Fund

  •   Insurance

  •   Banking

  •   Limited Partnership

  • Confirmation of informed consent

  • Referral requires completed consent form. Please Put full Name below if everything above is true.

  • You will join the following group(s):

* required information
For security purposes, please type the letters and numbers you see below.