*-denotes required field

Please fill in your info below and click on the SEND button.
Don’t forget to review our Terms and Conditions, which
appear at the bottom of this page.

First Name:*

Last Name:*

Organization Name:*

Type of Business*

Address:*

City*:

State:*

Zip Code:*

Your Email:*

Your Phone:*

Type of Names*:
 New Movers (including Apts) New Movers (excluding Apts)

Type of Delivery*:
 Email Peel & Stick Labels

Target Zip Code 1*:

Target Zip Code 2:

Target Zip Code 3:

Target Zip Code 4:

Target Zip Code 5:

Target Zip Code 6:

Target Zip Code 7:

Target Zip Code 8:

I agree to the Terms & Conditions below*:
 Yes No

Today's Date*:

Any Comments? Additional zip codes?


To finish PLEASE REVIEW our Terms and Conditions below and
click on the SEND button.

We know you will find our service to be a wonderful addition to
your advertising efforts. It can be a tremendous aid to the expansion
and growth of your business.

Terms and Conditions

* I will receive each month the names and addresses of new movers for
my areas on peel and stick labels or via email.

* Electronic files are sent via email with invoice on the first business day of
each month. Labels are sent on or about the 5th day of each month.

* A separate computer printout of all new mover names and addresses is
also included with labels at no charge. A printout is not included if I choose
email delivery.

* I will be billed monthly at 25 cents per name, plus a $5 monthly processing
fee. Price drops to 19 cents per name if I average 100 or more names monthly.

* An invoice will be included each month with my names and addresses.
Payment is to be made within 30 days of receipt of invoice.

* I will receive a credit during my first month for up to 100 free names.

* I may cancel at any time. However, I must notify your office to cancel on or
before the 20th day of the previous month. Otherwise I agree to pay for the
following month’s shipment of names. Also, upon cancellation I agree to pay
any outstanding invoices.

* Changes to my monthly order must be made by the 20th day of the previous
month.

* New mover names and addresses cannot be resold or supplied to others.

* Names and addresses cannot be returned for a refund, and unless I cancel
by the 20th day of the previous month, I am obligated to pay for my monthly
shipment.

* Names and addresses are compiled from various sources and are not
always accurate. No liability is assumed by Mike Shields and Associates for
any inaccuracies.

* The average postal return rate is 10-15%. I will receive a credit for each
undeliverable name I report to your office. Credits will appear on the following
month’s invoice. No credits for returns during my first month. Also, no credits
will be issued for returns older than 30 days and no credits or refunds after I
cancel my account.

* Although I may cancel at any time, to properly evaluate this service it is highly
recommended that I subscribe for a minimum of 3 months.

(PLEASE PRINT A COPY OF TERMS AND CONDITIONS FOR YOUR RECORDS)