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Principal Agency Partner(s)*
(Including the Principal) Total Number of Agency Staff upon Signing*
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Payment Plan Duration*
Amount due at Contract Signing*
Number of Planned Epic Seats Needed*
Free months in Epic
Free months in EZLynx
Planned Agency Launch Date*
Referral Payment Type
Base Commission Split*
Bonus Commission Split*
Bonus Premium Requirement*
Important Notes or Concessions:*
Any Existing Codes or Books?*