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Quote/Count Request Form

This form allows you to do a count request for your selected target list for your marketing campaign. This service is free and we will respond by the actual time frame and type of information being requested. We need you to be as accurate and complete on your requested selects/demographics and the geography by state, county and zip if needed. Please remember we have well over 120 million direct mail names consumer, 15 million business and 135 million e-mail addresses.

E-mail addresses are broadcasted by us for you with full reporting to you on the results, click troughs, and by hyperlink. You will need to supply the creative in HTML and text. We will send you full instructions. We have a 10,000 name minimum on all e-mail broadcasts as of 09/02/02.

Please submit your free count request and we will respond to everyone based on the sense of urgency. All we ask is that if we do your request then be responsive when we return your answers. It takes an average of 25-35 minutes of peoples time to get you what your looking for so be patient, we will get back to you. You may also call us: 818-575-3240 the count request needs to be filled out before you call for a quote please.

Thanks so much and the best of luck to you and your campaign. We can make a difference in your efforts, try us and you will see.

Quote/Count Request Form

1. Please provide Information as

2. How do you want to reach your potential target customer?
(Please specify E-mail or Direct Mail. You may additional select Telemarketing and Fax )

	E-mail
	Direct Mail
	Telemarketing
	Fax (business only)

3. Select how you would like us to contact you with your requested information:
(Choose phone to expedite your request)

Phone

Email

Fax

4. How many names are you looking for when we locate your ideal candidate?

5. When are you going to purchase this quantity for your project? (Select one of the choices below)

	1 Week		2 Weeks		3 Weeks		4 Weeks		1 month or more
This request is for information purposes only

6. In the text box below please provide a description of the type of products or services you offer in order to help us qualify our search process. By providing this information you will help us expedite your request.

7. In the text box below please provide us with a description and detailed information of your targeted-market profile. Please include details about age, gender, yearly income, occupation, and any other relevant details pertaining to who it is you wish market to. This information is needed in order to help us qualify our search process and will help us to expedite your request.

8. In the text box below please provide us with detailed information of your targeted-market profile geographical location. This information is needed in order to help us qualify our search process and will help us to expedite your request.

Personal Information: (fields in bold are required fields)

First Name:
Last Name:
Company Name:
Phone:
E-Mail:
Fax:
Street Address:
City:
State/Province:
Zip Code:
Country:

We would like your help and will reward you with a 5% discount on your first order if you would be so kind and tell us what search engine you came to us by. Thank you in advance for your help.

* If you choose "Other Search Engine" or "Other" from the list above please specify the name of the search engine here or any other details not covered in the list above thank you.