Order Form Print
and complete the form below. Fax to 415-459-7333. Or call us at 800-767-1969
for assistance.
Date
PO #
Bill To:
Ship To:
Name
Name
Title
Title
Organization
Organization
Address1
Address1
Address2
Address2
City
City
State
State
Zip
Zip
Country
Country
Phone
Phone
Fax
Email
Ship To Email
Subject Line
Mailer
ID Key
Offer
Mail
Date
Date Needed
(If
you need assistance, call 800-767-1969)
Datacard #
List Name
Quantity
Base
Price:
Base
Price - One Time Use $__________
Base
Price - 1-year unlimited $__________
Additional Selections:
Category/Specialty Select $5/M
Recency:
Keycoding
$5/M
12 Months
$5/M
Telephone Number
$25/M
6 Months
$10/M
Fax Numbers
$40/M
3 Months
$15/M
Employee size
$5/M
Sales Volume
$5/M
Rush Order
$50F
SIC Code
$5/M
Other
Selections
Title Addressing
$5/M
Formats:
State/Zip/SCF
$5/M
Pressure Sensitive Labels $10/M
Shipping:
Diskette
$50F
Std 2-Day $17.50 min.
CD ROM
$50F
Overnight $30
min.
Email Transfer
$50F
Note:
Please complete and fax to 415-459-7333. A
representative will contact you to review the order and pricing. If you need
assistance in filling out the order form, please call us at
800-767-1969 or 415-459-7400, or submit what you can and we will call you.
Thank you.
