Regular Membership Application

Company Name

Parent Company

Email address

Phone

Fax

Mailing address

Shipping address

Year established

Contact

Contact title

Please select all product types your company can deliver:: Doorhangers
Weekly Saturation
Total Market Coverage (TMC)
Yellow Pages
Newspapers
Magazines
Product Samples

Please List All States Where Your Company Can Distribute (if only in specific areas or metro areas within a state, please indicate which ones)

Total amount of households your company is capable of delivering weekly:

Type of delivery system: Carrier Routed
Crew
Other (please explain)

Other type of delivery system

Method of delivery: % Placed on Porch
% Door Knob Hung in Plastic Bag
% Thrown in Driveway
% Placed in Company Owned Tube
% Delivered with Daily Paper
% Delivered with Weekly Paper

Type of delivery agent: Adult
Supervised Youngsters

Delivery days: As Customer Requests
Specific Days, which are...

Specific delivery days

Customers may select: Zip Codes
Demographic Areas
Customer Designed Delivery Areas

Other services available: Printing
Mailing
In-Store
Display Advertising
Other...

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