Company:

Contact:

Contact Title:

Street:

City:

State:

Zip Code:

Tel:

Fax:

Email:

Website:

Category 1:

B2B

B2C

Both

Category 2:

Catalog

Consumer Services

Publishing

Other

Category 3:

Retail Trade Area

Retail Prospecting       Models

9-Digit ZIP       Preselect Models

Online New Customer       Acquisition

Other

Total Number of Store Locations?

Can we add you to our direct mail promotional database? Yes No

Can we add you to our e-mail promotional database?       Yes No

The answers to the following questions will be kept confidential:

How many names a year do you currently mail (House File)?

How many names a year do you currently mail (Outside Lists)?

How many times a year do you mail?

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