SAMPLE REQUEST FORM
This form is for gathering information to create an accurate sample package for you. Please be as descriptive as possible so we can give you what you are looking for. Please do not hesitate to call us if you would rather talk with someone in person.

Name:

Dealership:

Phone:

Fax:

E-Mail:

Address:

City:

State/Zip:
  
Franchise(s):

Desired delivery date:


What's the best way to contact you?
Telephone
Fax
Email
Other (explain below)

What would you like samples of?
Electronic (TV and Radio)
Print (Direct Mail, Inserts and Newsprint)
All of the above

How would you like your samples sent?
Email
USPS
Fed Ex

What is your title?


Best contact explanation if needed:


Optional Description or Comments