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Your Name (First and Last) *

Your Email Address *

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Publication Name *

Partner Name

Publication Type *

Weekly

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OtherOther

Billing Adress *

Publication Date *

Creative Assistance *

Creative Assistance $50

No Assistance Needed

Quantity *

Number of Recipients Desired

From Line *

Seen by subscribers as sender

Subject Line *

Seed List

One Email address per line, up to 6 maximum. These people will receive the test and campaign

Clickthrough Link *

For Multiple clickthroughs use the additional notes field.

Geographic Target Area *

Metro Area, Zipcodes, Town Names, Etc.

Start Date *

End Date *

Additional Instructions/Notes:

Terms & Conditions *

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