Email Blast Request Form

Requested by:

Contact Name: *
Company Name:
Address:*
City:*
State:*	--SELECT STATE-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming --SELECT TERRITORY-- American Samoa Fed. States of Micronesia Guam Marshall Islands Northern Mariana Islands Puerto Rico Virgin Islands --SELECT US MILITARY-- Armed Forces of the Americas Armed Forces Europe Armed Forces Pacific --SELECT CANADIAN PROVINCE-- Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territories Nova Soctia Nunavut Ontario Prince Edward Island Quebec Saskatchwean Yukon Territory --OTHER-- Other Province/Territory
Zip:*
Daytime Phone:*
Email:*
Fax:

Number of email blasts to be sent:*

Requested Date(s) for email to be sent:*
(Emails are sent Monday through Friday only)

Quantity of email addresses to be sent:*
(Minimum order - 1,000 email addresses)

Subject line of email:*

Upon receipt of email blast request form, an invoice will be emailed or faxed. Prepayment is required.

Thank you for your email blast request. Please email your content for the email blast to headquarters@theaeap.com. All graphics should be imbedded into the email design. Any conversion or design work performed by AEAP will cost an additional $100. AEAP must approve email piece.