BROOKSIDE AGENCY MAILING LISTS
REQUEST FOR QUOTATION

Please print this form, fill in the spaces, then phone, fax, email, or mail it to the address or numbers at the bottom.
Your Name:
Business Name:
Address:
City, State, Zip
Telephone:                                                                         Fax:
E-Mail: 
Type of List:
Geography or parts of country (cities, towns, zips, and states) you want your list to target:
.
.
.
Product(s) you are marketing:
.
Category of mailing list or S.I.C. code: 
Target mailing list:   [   ] Consumer      [   ] Business
Do you need phone numbers?  [   ] Yes   [   ] No
Diskette format:  [   ] .txt   [   ] .xis (Excel)   [   ] Other: __________________________________________________
.
Method of shipping:  [   ] Fed Ex   [   ] UPS   [   ] US Postal Service   [   ] E-mail    [   ] 2nd Day   [   ] Next Day
.
Quantity: [   ] 3,000 to 5,000    [   ] 5,001 to 10,000     [   ] 10,001 to 15,000     [   ] 15,001 to 25,000
              [   ] 25,001 to 50,000   [   ] 50,001 to 100,000
.
[   ] Please send a mailing list quotation as described above.  [   ] Copy of my advertising piece is attached.
Signature:                                                                                            Date:

Brookside Agency

Print the form, fill in the information, then . . .

Mail the form to:  Brookside Agency, PO Box 1327, Medford, Oregon 97504-4932

Phone your request for quotation:  541-734-5605

Fax your request for quotation to: 541-779-2586

Email your request for quotation to: lists@brooksideagency.com (copy and paste to the email)

Web Site:  brooksideagency.com

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