Submit a Lead

Your Full Name *

Your Email Address *

Your Phone Number

Your Rep ID / Code *

Date of Lead Conversation *

Client First Name *

Client Last Name *

Client Business Name *

Client Industry *
-- Select Industry --Contractor / Home ServicesHVACPlumbingElectricalRoofingFencingGeneral ContractorLandscapingCleaning ServicesReal EstateInsuranceMedical OfficeRestaurant / Food ServiceAuto RepairCar DealershipFitness / GymSalon / SpaFurniture SalesOther

Client Phone Number *

Client Email Address *

Client City

Client State
-- Select State --ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

Package Sold *
-- Select Package --Core System — $2,997 setup + $497/moGrowth System — $4,997 setup + $597/moConcierge System — $5,997 setup + $697/mo

Setup Fee Amount *

Monthly Fee Amount *

Any Discounts or Custom Pricing Applied?

Payment Method *
-- Select Method --Paid Online via StripeNeeds Phone PaymentInvoice Requested

Payment Status *
-- Select Status --Paid in FullDeposit Paid — Balance PendingPending — Not Yet PaidNeeds Follow-Up

Stripe Transaction ID (if paid online)

Best Time to Call Client (if phone payment needed)

Payment Notes

Lead Source *
-- Select Source --Cold CallWarm ReferralInbound InquirySocial Media / DMDoor Knock / In PersonEmail OutreachOther

Lead Temperature *
-- Select Status --Closed — SoldHot — Very Interested, Follow-Up NeededWarm — Interested, Needs More TimeCold — Not Ready Yet

What pain points did the client mention? *

What objections came up, if any?

Additional Notes for the Orbintra Team

Does this lead need a follow-up from Orbintra? *
-- Select --Yes — Please reach out to close or collect paymentYes — Client has questions before committingNo — Already handled, just logging the leadNo — Client said not interested at this time

Requested Follow-Up Date

Requested Follow-Up Time / Window

Preferred Contact Method for Client
-- Select --CallText / SMSEmailCall then Text if No Answer