ULTIMATE INSURANCE SYSTEM
Mailing Count Request and Order Form
Name______________________________
Address ____________________________
City _______________ State ___________
Zip code ____________________________
Phone ______________________________
Fax ________________________________
Email __________________________________________________
(Please print clearly because we email you the list)
AFFLUENT AMERICANS (Prospects with 401K, and IRA issues.
Affluent Americans file age 55 to 65 age group with incomes over $100,000. Pulling the pre-retired market, getting a large percentage
with IRA and (401) K rollover issues they need to solve. Only homeowners on this list. This file is pulling
from a large database of 115 Million updated monthly.
Or you can select the following: age ____65-78 you select age _____________
I want Affluent Americans $100,000 incomes within a 20 mile radius of the following zip code ________
____ Yes, I want 1,000 affluent Americans for $350.00 (Phones where available)
____ Yes, I want 2,000 affluent Americans for $400.00 (Phones where available)
____ Yes, I want 3,000 affluent Americans for $500.00 (Phones where available)
____ Yes, I want 5,000 affluent Americans for $600.00 (Phones where available)
HIGHLY TARGETED LISTS
I want 1,000 CD Holders within a 20 mile radius
of the following zip code ________
The cost for this list is $350.00 for 1,000 names. ____ Yes, please order me
this list.
I want 1,000 IRA Holders within a 20 mile radius
of the following zip code ________
The cost for this list is $350.00 for 1,000 names. ____ Yes, please order me
this list.
I want Affluent Widows age 65-78 with assets over $150,000 within a 20 mile radius of the following zip code ________
List is compiled with 8 different profiles.
____Yes, I want 1,000 affluent widows for $350 (Phones where available)
____ Yes, I want 2,000 affluent widows for $400.00 (Phones where available)
Credit card #___________________________________ Exp. Date__________
Signature _________________________ Last 3-Digit code on back of CC _________
All orders are final. No refund on lists. You own these lists, not rented Fax back to 1-800-397-3840
for list count or to order. Allow 1-2 days for results or delivery. Lists are emailed to you in Excel Program.
Questions call: Russ at 1-435-563-4749
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