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Company Name*

Industry

Phone*

Email*

Please send me the Kirkwood Direct newsletter

Services (Check all that apply):*

	Turnkey Direct Mail			Data Services
	Printing			Mailing Lists
	Fulfillment/Kitting			Lettershop/Mailing Services
	Prospect Seeker			Postal Optimization
	E-Marketing			Insert Media
	Variable Print			Crisis Mail Management

Anticipated Mailing Date:

Anticipated Quantities* (Enter all quantities that apply)

Lettershop Specs and Description*
(Include as much information as possible including size of mailing piece, type of piece (postcard, envelope mailing, etc.), and any other important information)

Type of Data Needed*

	My Customer List	Saturate List (every household)
	Consumer List	Business List
	Other
If other, please explain:

Printing:*	All my pieces are already printed
	My pieces are designed, would like a print bid

Printing Specs:

Postage Type:*

Indicia or Live Stamp?

Indicia

Live Stamp

Inserts*

Size:

Quantity:

Paper Stock:

Do you need media placement?

Other Insert Details:

Other:
Include any other direct marketing needs or requests.