APSPostcards.com

Lead Generator Order Form
Complete the form below.  Print and fax all pages to (480) 922-0137.
First Name Last Name
Company
Address Suite/Apt
City State        ZIP
Phone Fax
E-mail

Postcard Option   Make sure only one box is checked

FlexDex Multi-Choice Elite Annuity

 Investment Strategy

 
Life & Long Term Care Insurance

 Is Your Nest Egg At Risk?

 
Annual Review

 

Logo Image Option   Check off one option only.  This image will appear on the back of your postcards.

Generic

 Allianz

Prospect List Demographics

Number of names:

Zip Code:      Alternate Zip Code:

Age Range: to

Income Level (check any that apply):

$15,000-$19,999
$20,000-$29,999
$30,000-$39,999
$40,000-$49,999
$50,000-$74,999
$75,000-$99,999
$100,000-$124,999
$125,000-$149,999
$150,000-$199,999
$200,000+

 In order to ensure the phone numbers on your prospect list are not on the Federal Do Not Call List, you must subscribe to the FTC's Do Not Call Registry.  Your EIN (Employer Identification Number) or SSN (Social Security Number) is required.

EIN OR

SSN

Payment

Card Type:

Credit Card Number:      CVV2: What's this?

Card Expiration Date:

If name on card or billing address is different than above address, enter it here: