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MAILERS AND LISTS ORDER FORM

Prices vary depending upon format, color and volume.
Please email info@kramerdirect.com or call Toll-Free 888-572-6373 for details.

List Selections (Indicate Below) ... or... Query #

(from List Count Page)

Age Range:		& Over
or		to

Estimated Income:

$20K+	$30K+	$40K+	$50K+
$60K+	$75K+	$100K+	$150K+
Other

(Note:Estimated income is not guaranteed)

Phone Numbers:

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Click to register for SAN (required if phone #s selected above - include hyphens)

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Special Dwelling Type:

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Special Gender Select:

Female Priority

Females Only

List zip areas or counties in priority order. Zips will be used in that sequence until desired quantity is reached.

1.			3.			5.			7.			9.
2.			4.			6.			8.			10.

PAYMENT

Paying by:

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Name on Credit Card:
Address where statement is sent:
City:	State:	Zip:

Please call 888-572-6373 with your credit card number, expiration date and security code.

If paying by check, print this completed form and mail with check to:
Kramer Direct; 100 N Central Expressway, Suite 300; Richardson, TX 75080.

	** required field
** Name:
Company:
** Address:
Suite:
** City:
State:**		Zip Code:**
** Phone:	( ) -	Ext
Fax:	( ) -	Ext
** E-Mail:

Comments:

_____________________________________________________________________________________________

Kramer Direct • 100 N Central Expressway, Suite 300 • Richardson, Texas 75080
972-231-3335 • 888-KramerDirect (888-572-6373) • Fax 972-231-9335
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