Luminos - Internal Design Request Form

Your full name* This field is required.(Please provide your name as you would like it to appear on your marketing designs etc.)

First Name

Last Name

Your business/company name* This field is required.

Your NPN* This field is required.(National Producer Number)

Email address to use in the design(s)* This field is required.(Best email for customers to contact)

example@example.com

Phone number to use in the design(s)* This field is required.

Area Code

Phone Number

Shipping address to receive your order* This field is required.No PO Boxes allowed

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Website or HealthSherpa link:Please provide the link/URL you would like to appear on your marketing materials.

Language for your marketing designs* This field is required.

English

Spanish

Vietnamese

Choose your marketing material* This field is required.Turn-around times will vary based on type of project, number of open projects and how many cups of coffee we've drank. (*Premium projects require more Marketing Miles and some will require monthly payments using your Miles.)

Medicare Postcard ~ FREE! *(No design changes, your contact info ONLY)

Social Media Ad Design ~ 50 Miles

Business Cards (250) ~ 50 Miles

Horizontal Banner (3x6ft) ~ 100 Miles

Club Flyers (250) ~ 200 Miles

Retractable Banner (6x3ft) ~ 250 Miles

Custom Pens ~ 250 Miles

Table Cover (6ft) ~ 250 Miles

*Premium: Logo Design ~ 500 Miles

*Premium: Email Marketing ~ 500 Miles

*Premium: In-Person Event Setup ~ 500 Miles

*Premium: Analytics, Data, SEO and Integrations ~ 1,000 Miles

*Premium: Website Design ~ 2,000 Miles (+100 Miles Per Month to host)

*Premium: Social Media Management ~ 500 Miles Per Month

Which business card template would you like to use?* This field is required.

BC Purple

BC Blue

BC Green

BC Red

Which banner template would you like to use?* This field is required.

Banner Blue

Banner Purple

Banner Light

Which social media template would you like to use?* This field is required.

Social Blue Yellow

Social Purple

Social Blue Brown

Social Teal

Social Blue Orange

Social Healthcare

Social Lost Coverage

Which club flyer template would you like to use?* This field is required.

ACA Purple

ACA Pink

Medicare Blue

Medicare Teal

Life Insurance

Dental and Vision

Which retractable banner template would you like to use?* This field is required.

Blue English

Blue Spanish

Teal English

Teal Spanish

Orange English

Which pen color would you like to use?* This field is required.

Blue

Green

White

Pink

Yellow

Silver

Red

Purple

File Upload: Provide any logo files, photos, etc, to use in your design(s)

Drag and drop files here

Select files to upload

Max. file size: 24.4MB

Describe your project in full detail: Please provide any specific information, content, messaging, your markets, or colors you want in the design.* This field is required.(With a limited two rounds of revisions, please be as specific as possible)

Do you need to change any billing information?* This field is required.Here is what we have so far. This is where your receipt and any invoice for this request will be sent: Name: {Name} Business Name: {Company-Name} Email: {Email} Phone: {Phone} Address: {address}

No, I do not need to make any changes to my billing information.

I need to update the billing name.

I need to update the billing business name.

I need to update the billing email.

I need to update the billing address.

I need to update the billing phone number.

Billing Name

First Name

Last Name

Billing Business Name

Billing Email

example@example.com

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Billing Phone Number

Area Code

Phone Number

And that's it!

Once you SUBMIT we will get started working on your design requests. If we need anything further, we will contact you with the information you provided.

Once the design is finished, we will email you a proof.

Please respond in a timely manner with approval or any changes.

Time to knock your design out of the park!

Date

Luminos - Internal Design Request Form