BlackPages.com - Mailing List Order Form

BlackPages.com Mailing List Order Form

Select the items below that you would like to order. Use the e-mail text area to send us a detailed description of the search criteria you want us to use, such as what city, state, or group of states you would like us to pull the list from. Your transaction will be confirmed by email.

Consumers (1000 Contacts) ($ 200.00 each) Quantity:
Income Opportunity Seekers (1000 Contacts) ($ 200.00 each) Quantity:
High Income Households (1000 Contacts) ($ 200.00 each) Quantity:
Business Owners (1000 Contacts) ($ 200.00 each) Quantity:
E-mails (20,000 E-mail Addresses) ($ 1000.00 each) Quantity:

GENERAL INFORMATION

First Name:	Last Name:
Address:
City:	State: Zip:
Country:
Phone Number:
E-Mail Address:
Email Text:

CHECKING ACCOUNT INFORMATION

At the bottom of your check is a series of numbers, separated by symbols. It is not necessary to enter symbols or spaces in the fields provided below.

Enter the series of nine numbers
between this symbol

Enter the series of numbers
found before this symbol

Check number to use: (Not required.)

Note: Some banks use a non-standard format in this series of numbers. If your account number includes this symbol , simply disregard the symbols and enter this section of numbers.

CREDIT CARD INFORMATION

Card Number:

Exp. Date:

Submit this form ONCE ONLY. Your transaction should be completed in 10-60 seconds, depending on Internet traffic. In some cases, it may take longer.