Representing Funeral Advantage – Agent Website Program

Your Information

First Name*

Last Name*

Email Address*

Phone Number*

If you are an MGA with Lincoln Heritage, your agency name on file will be used across the website instead of your personal name.

Business Phone Number*

This field is hidden when viewing the form

Business Name

Business Address*

The address you provide will be publicly displayed on your website. Do not enter your home address.

* Business Street Address Business Street Address 2 * Business City * Business State * Business Zip Code

Business Hours ( check all that apply )*

Start Time*

End Time*

Photo Upload (max 3 photos)*

Drop files here or

Max. file size: 50 MB, Max. files: 3.

**If you use stock photos, you are required to comply with all federal and state laws.

Bilingual*

No
Yes - (In order to have a bilingual website, you must have a Spanish writing number and be verified by our Spanish department.)

Default Website Language*

Bio - English (max 1200 characters)*

Bio - Spanish (max 1200 characters)*

Preferred Agent Url

https://agents.lhlic.com/

Website Design ( click to enlarge )*

This field is hidden when viewing the form

Color ( select one )*

As an Independent Contractor in all of your dealings with Lincoln Heritage Life Insurance Company® (Lincoln Heritage), your participation in this Service does not make Lincoln Heritage a party of this contract. This agreement is solely between Skyhook Interactive and you, the Agent.

Name

This field is for validation purposes and should be left unchanged.