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Count or Quote Request Form

So that we may assist you in developing a successful campaign, please complete the following:


Company Name:
Contact Name:
Address:
City:
State:
Zip:
Area Code & Phone:
Email Address:

What type of marketing campaign are you planning for?
Direct Mail  Telemarketing
Type of list you are looking for:
Consumer   Opt-In Email   Business

Demographic Selections:

Age Range (e.g. 25-75)

Income (e.g. $35K+)

Options: Select all that apply
Homeowner  Married  Renter  Telephone


There are many options available, too numerous to list, please enter any others you would like:


Lifestyle Selections: (e.g. golfers, skiers, casino gamblers, etc.)
Please List


Geography Options:

Zip Code:

State:

County:

SCF:

Other:


Contact Us if you   would like Credit Scores

What product/service are you offering to your prospects?

When are you wanting to do your marketing campaign?

How many names are you looking for?

How often do you purchase names?

Is there anything else you would like us to know about this campaign?


 

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