Arm Leads - Order: Online Order Form

Order Form

Online Order Form

Welcome to ARM's interactive Online Order Form. Please fill out this form as completely as possible. Fields marked with an (*) are required. An ARM representative will be in touch with you shortly after you submit the form to confirm the order. Thank you very much!

Customer Information

Please enter all of your information for your order.

Company Name:

Full Name:

Phone #:

Email Address:

Address

Street Address

Address continued

City

State

Zip

Your sales representative (if you know):

Billing Information

Is the Billing Information the same as above? *

Customer Billing Information

Please enter all of your billing information for your order.

Company Name:

Full Name:

Phone #:

Address

Street Address

Address continued

City

State

Zip

Shipping Information

Preferred Shipping MethodDigital Leads - No hardcopiesFirst-Class Mail Special ShippingDigital Leads & Hardcopies (Add $25 per thousand)

Is the Shipping Information the same as the Billing Information?

Recipient Name:

Email Address: *

Shipping Information:

Full Name:

Street Address

Address continued

City

State

Zip

Special Instructions

Digital Lead Information

Recipient Name:

Email Address:

Hardcopy Lead Information

Full Name:

Street Address

Address continued

City

State

Zip

Order Information

Type of Mailing:Lead GenerationSeminar MailingMailing List Only

How do you want your mailing list?

Query Number

You can get a query number by running your own counts through our online count system.

If you do not have a query through our online count system, then please check here to fill out your demographics & area

Demographics & Area

Program Type

If you do not know the piece you wish to order, leave the Program Type blank.

Demographics:

Age:

Sample: 65+

Income:

Sample: $30,000+

SelectsHomeowner ($5 extra per thousand)

FTC SAN# (Required for Phones)

Quantity:

Total # of pieces to mail - minimum 2000

Do you want a full mailing list with your order? (Add $25 per thousand)

How do you want your mailing list?

Seminar Information

Seminar Description

Seminar Location

Street Address

Address continued

City

State

Zip

Seminar Date(s)

Seminar Time(s)

Which answering service are you using?

Answering service to call & confirm attendance 24 hrs in advance?

Answering Service Phone #

Agent E-mail / Fax (Confirmation Reply)

Program Type

Other Piece Name

If you do not know the name of the piece you'd like to mail, then you can leave this field blank.

Demographics:

Age:

Sample: 65+

Income:

Sample: $30,000+

SelectsHomeowner ($5 extra per thousand)Phones ($25 extra per thousand)

FTC SAN# (Required for Phones)

Quantity:

Total # of pieces to mail - minimum 1000

Do you want a full mailing list with your order? (Add $25 per thousand)

How do you want your mailing list?

State:

To add additional states, click "Add another response"

List Type:

Zip Codes:

Please list your zip codes in order of priority. To add additional zip codes, click "Add another response".

I have a file with all the zip codes on it.

Optional: If you have a file of the zip codes, you may alternatively upload them here

Counties:

To add additional counties, click "Add another response"

SCF Code:

This is the first three digits of a zip code area.

Dislcaimer

I need to add a disclaimer that will meet the local requirements.

For which State?

License #

Our standard disclaimer for CA is: Information provided by CA License #123456

Agent Information

Our standard disclaimer for TX is: Financial and Insurance products may be offered by "Agent Name & Address"

Disclaimer notes:

If you need a custom disclaimer, please enter it here.

Additional Comments

Enter any additional comments you may have here

Please enter the characters you see in this picture:

Characters

This helps prevent automated form submissions. If you are not sure what the characters are, make your best guess. You will have another try in the next screen.
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