Client Stream - Direct Mail

Direct Mail Order Form
This order form is for requesting Direct Mail leads via the Client Stream Lead Exchange.

Leads are billed upfront and if the leads are not delivered, a refund will be issued for the differance.

This is an example of the card consumers will complete

You will receive a copy of the actual card filled out
In this program rather than paying for a direct mail drop, you only pay for a lead card returned. Since normally only 1% of cards are returned, this is a huge plus to using Client Stream for your direct mail needs.

Because of this pricing structure please note that we cannot guarantee what content will be on the returned mail card. The risk is no different than the risk when you paid for the drop.
The drop will be statewide, but the vendor will attempt to drop as close to the requested county as possible.
What is the vertical you want to target?*
Select a State*
Select the state you want to purchase leads in. Pricing is included per state
What is the primary county you would like to target?*
Enter the desired targeted county of the state you selected above.
Number of Leads Per Drop*
The number of leads you wish to receive from your selected state. Minimum number of leads per drop is 20

Name of Company*
Use the same company name as you signed up with in the Client Stream Lead Exchange platform.
Name of the agent receiving leads*
Enter the name of the agent who is receiving the leads. If the leads are for you, enter your own name. Some states require the name of the agent to appear on the mail card.
What is the agent License Number?
The License Number of the agent is required to appear if you selected Texas as your state.
What email do you want notified of new leads?*

Confirmation EmailYour email address is required twice in order to confirm it is accurate.

Point of Contact Name*

First NameLast Name
Point of Contact E-mail*

Confirmation EmailThis can be the same as the agent receiving the leads but does not have to be if someone is ordering on your behalf. This should be the person we will contact if there are questions about the order.
Point of Contact Number*

Authorized By*

First NameLast Name
By clicking on the below "I Agree" button, I authorize Intelemedia to charge the credit card on file for the number of leads at the cost specified.
Authorization*

I agree
Please verify that you are human*
Should be Empty:

Direct Mail Order Form