Email Order Form

Date of Request-          

Date of Deployment-

Order Number/ID:
 

Client Contact Information
Mailer:

Broker/Agency:
Contact Name:
Phone:
Email:

List Name:
Number of Records:

Selects to be used for mailing-
1.  2.
3.  4.
5.  6.
7.  8.

Supressions:
Merge/Purge:
A/B Splits:
Priority:
Deduping:
Other:

Message/Campaign Information-
1. Please indicate which are included:
    Text
    HTML
    AOL
2. Please indicate which are included:
   Track All
   Track None
  Track Only the following: (enter URLS to be tracked below)
   
   
   
   
   

From Name:		 

Subject Line:

Seed List - Test and Live Messages --- Note: add any others from previous campaigns
Enter email addresses below
 
 
 
 
 
 

Other Information -
Credit Card Information -
Card Type: MasterCard Visa American Express
Card Number: Security Code
Name on Card:
Address on Card:
Street
City Zip
Expiration (MM/YY):