Casa Customs Gift Program Agency Roll-Out
Account Manager Name
*
Account Manager Email
*
Agency Name
*
Your Name
*
Your Email Address
*
Brochure
Which cover design format would you like?
*
OPTION A (The two colors would complement your logo)
OPTION B
Select which agency benefits you'd like highlighted on Page 2 of the brochure.
*
Claim Satisfaction Guarantee
Loaner Car Assistance Available
Windshield Repair Assistance
Higher Liability Limits
Cancel Current Policies
Personal Claims Assistance
Extended Hours
24-Hour Contact Line
Platinum Package for Auto
Annual Reviews
Custom Tailored Policies
Community Charity Initiatives
Monthly Community Magazine Publication
Serving Our Community for Over ____ Years
Other
How many years should be inserted for "Serving Our Community" highlight?
How many brochures would you like printed?
*
Minimum quantity is 100. Cost is $1.50/each + $18 shipping per order.
Brochure Printing & Shipping Total
Total to be charged to your credit card on file:
Email Notifications and Gift Approval
Provide the names and phone numbers and/or email addresses to include in the email signature area.
Provide the email addresses that should receive notifications every time a new business registration or new referral occurs.
*
Provide the email addresses for any team member that you would like to have access to either APPROVE gift orders or review shipment status.
*
Gift billing:
Supplier can use the credit card on file with AMM
I'll fax a new Credit Card Authorization form
Gift Samples
Would you like to order any gifts to use for presentations now?
*
Yes
No
Gift Shipping Address
*
Street Address
Street Address Line 2
City
Please Select
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
State
Zip Code
Gift Selections
*
A. 2 Mason Jar Glasses and 2 Slate Coasters
B. 2 Stemless Wine Glasses and 2 Slate Coasters
C. Leather Coaster Set of 6 with Holder
D. Slate Coaster Set of 4
E. Bamboo Coaster Set of 4 with Holder
F. Bamboo Cutting Board
G. Leather Koozie Set of 4
H. 4-Piece Wine Tool Kit with Leather Case
Total Gift Sample Cost
Includes $6 shipping fee (per item)
Select Personalization Option
Last Name Initial and Full Last Name
Person 1 First Name Initial & Person 2 First Name Initial
Enter Last Name
Last Name of Family in CAPS
Last Name Initial
First Initial of Last Name in CAPS
First Name Initial 1
First Initial of Person 1 First Name in CAPS
First Name Initial 2
First Initial of Person 2 First Name in CAPS
Message on Gift Tag
CONGRATULATIONS ON YOUR NEW HOME!
Will appear in all CAPS
0/38
Salutation on Gift Tag Line 1
(leave blank)
0/40
Salutation on Gift Tag Line 2
(leave blank)
Recommendation: Use a fictitious mortgage broker name
0/40
Salutation on Gift Tag Line 3
(leave blank)
Recommendation: Use a fictitious company name
0/40
Submit
Status
Should be Empty: