INTERNATIONAL MARKETING LICENSE INTEREST

Please provide us with the following information:

First Name

Last Name

Company name (if applicable)

Address

City

If in the USA or Canada: State/Prov

 Other:
Country

Postal code / ZIP

Telephone

 Cell:

Fax

E-mail
Most of our communication with you will be done via email
 
Level of participation you are interested in: 
Referrals only  Opening new markets Training/trainer
Agent  Seminars/Workshop:
Promote and/orOrganize 		 Management
Other:
Market(s) you can reach? Entrepreneurs Home Owners  Licensed Agents
Others:
How would you reach that market(s)?
Country(ies) in which you can/want penetrate the market?

America
Argentina  Canada Jamaica  United States
Bahamas Chile Mexico Uruguay
Bermuda  Colombia Paraguay Venezuela
Bolivia Guatemala Peru 
Brazil  Honduras Puerto Rico
Other:

Asia
Australia India New Zealand Thailand
Brunei  Indonesia Philippines Vietnam
China Japan Singapore 
Hong Kong  Malaysia Taiwan
Other:

Europe
Austria  Greece Luxembourg Spain
Belgium Greenland Monaco Sweden 
Denmark Iceland Netherlands Switzerland
Finland Ireland Norway United Kingdom
France  Italy Portugal
Germany Liechtenstein Russia 
Other:
Language(s)? You can speak which language(s):

 You have a team/direct contacts who can work in which language(s):
Accessible/existing database?
Total number of names:

How many with address:
How many with phone #:
How many with email address:
In the database above, how many could be potential:
Year 1 Year 3 Year 5
Clients:
Agents:
Leads Generators:
Trainers:
Market developers/promoters:
If applicable, what type of license in financial services do you presently or did have? Not applicable Life Insurance   Securities   Mortgage
Other:
Please tell us how you see yourself and/or your group working with us:
Why should EQ work with you in developing new markets?
What is your strategy to market EQ?
BUDGET elements:

Please fill out this chart if you already have an idea of the budget needed for the region/country(ies) you are interested in.

The self-supported section is to determine if you can invest your own money into this, or if you need to raise funds (or EQ financial support). The word "Part" here stands for "Partially". 
Elements Estimated cost range Self supported?
Minimum Maximum Yes No Part
Licensing fee US$10,000 US$1,000,000
Initial setup
(office, training, etc)		 US$ US$
Marketing US$ US$
Operations US$ US$
Management US$ US$
Others US$ US$
If you cannot self-support the costs above, do you know someone who has the funds and who might be interested in a joint-venture with you? Yes   No  Maybe
Referred by:
Any comments or questions?:

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