Order Form

ORDER FORM

Please fill in your info below and click on the Submit button. Don't forget to review our Terms and Conditions, which appear at the bottom of this page.

* indicates required fields

*First Name:

*Last Name:

*Organization Name:

*Street Address:

*City and State:

*Zip Code:

*Phone:

*Fax:

*Email address:

*Choose Type of Names:

New Movers (including Apts)
New Movers (excluding Apts)

*Choose Delivery Method:

Email
Peel and Stick Labels

*Zip Code 1:

Zip Code 2:

Zip Code 3:

Zip Code 4:

Zip Code 5:

Zip Code 6:

Zip Code 7:

Zip Code 8:

Zip Code 9:

Zip Code 10:

*I Agree to Terms and Conditions below:

YES
NO

*Today's DATE:

Any comments?:

To finish PLEASE REVIEW our Terms and Conditions and click on the Submit button above. We know you will find our service to be a wonderful addition to your advertising efforts. It can be a tremendous aid to the expansion and growth of your business.

Terms and Conditions

* I will receive each month the names and addresses of new movers for my areas on peel and stick labels or via email.

* New Mover list and invoice will be sent to me via First Class Mail on approximately the 5th day of each month. Email files are sent on the first business day of each month.

* A separate computer printout of all new mover names and addresses is also included with labels at no charge. A printout is not included if I choose email delivery.

* I will be billed monthly at 25 cents per name, plus a $5 monthly processing fee.

* An invoice will be included each month with my names and addresses. Payment is to be made within 30 days of receipt of invoice.

* I will receive a credit during my first month for up to 100 free names.

* I may cancel at any time. However, I must notify your office to cancel on or before the 20th day of the previous month. Otherwise I agree to pay for the following month's shipment of names. Also, upon cancellation I agree to pay any outstanding invoices.

* Changes to my monthly order must be made by the 20th day of the previous month.

* New mover names and addresses cannot be resold or supplied to others.

* Names and addresses cannot be returned for a refund, and unless I cancel by the 20th day of the previous month, I am obligated to pay for my monthly shipment.

* Names and addresses are compiled from various sources and are not always accurate. No liability is assumed by Mike Shields and Associates for any inaccuracies.

* The average postal return rate is 10-15%. I will receive a credit for each undeliverable name I report to your office. Credits will appear on the following month's invoice. No credits for returns during my first month. Also, no credits will be issued for returns older than 30 days and no credits or refunds after I cancel my account.

* Although I may cancel at any time, to properly evaluate this service it is highly recommended that I subscribe for a minimum of 3 months.

(Be sure to print a copy of Terms and Conditions for your records)