ACCOUNT INFO

Your Name*:                     Middle Initial*:

Company Name*:            Referring Company/Affiliate*: 

Bill To Street Address*:                    

City*:       State*: AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY        Zip*:

Office Phone*:      Mobile Phone:       Fax*:

Email Address*:     Birthday (mm/dd)*:

Referral Reward Preference*: Just Stay In Touch Credit Staples Gift Card Starbucks Gift Card Blockbuster Gift Card

ENVELOPE INFO

What would you like printed as your return address on your envelopes?*:

Line 1:

Line 2:

Line 3:

Line 4 (optional):

MAILING INFO

Which of the Mailing Program(s) you would like to utilize?* (Select all that apply) Closing Follow Up Sphere Mailings Birthday Mailings Client Follow Up    

If you selected the Sphere Program above, please complete the following:

           1) Which frequency do you prefer?: Monthly Bi-Monthly Quarterly Semi-Annually Annually       

           2)  If you know which cards you would like to use, please list them here along with their appropriate mail month:

            (List your mailings for at least the next 12 months.)  (If you are not sure, leave blank and we'll help you.)

            Quarterly Example: November 2006-Harvest Time (HT100-200); February 2007-Red Hots (RH100-225); May 2007-American Flyer (LGC63-200); August 2007-Balloons (97207)

 3) What Personalization Imprint would you like printed on your cards?:

Line 1:

Line 2:

Line 3:

Line 4 (optional):

BILLING INFO

Credit Card Type*: American Express Visa Mastercard   (We'll contact you during the sign up process to collect your card number, exp. date and ID#.)

Cardholder Name*:

Cardholder Address*:  

City*:     State*: AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY      Zip*:

CLIENT INFO

If you would like to add any of your past clients (or your current client list) to the mailing programs listed above, please send us the information as a Microsoft Excel Spreadsheet (file type *.xls or *.csv).  Separate into the following columns: client name (First Last), address1, address2 (if needed), city, state, zip.  If applicable, be sure to also send us the closing/birth/reference date and which of the program types to add them on.

Example Entries:

Email file to: info@juststayintouch.com

AUTHORIZATION

By clicking "Authorize" below, I authorize Just Stay In Touch, Inc. to set up a new customer account and to bill my account by credit card, as indicated, for mailing services provided.  I understand that if I have an invoice past due, Just Stay In touch, Inc. reserves the right to apply late fees &/or cancel my remaining scheduled mailings.

NEXT STEPS:

    1)  mail us a stack of your business cards, if you'd like them included in your mailings (optional).  We'll inventory them and let you know when we start to run low.

    2) supply us a sample of your signature.  Sign your FIRST name only, several times, on a blank, white sheet and fax or mail it to us.

    Send info to: 

        Just Stay In Touch, Inc.

        1000 East Belt Line Road, Suite 210

        Carrollton, TX  75006

        FAX: 214-227-2529

        Questions?  Call us!  866-430-2789