You are ordering Direct Mail for University Painters by using this form.

Please note as of January 2019 direct mail is now $0.5175 per piece. Also, there is a $5.00 service charge for each processed order.

*Required Fields
basic info:
*Name: *Email Address: *Phone:
order info:
1. Choose Date
Please note these are approximate dates and could change.


2.

Please note: If you are ordering for multiple names you must fill out seperate forms for each one.

All Areas Below Must Be Filled Out for Every Drop Order.
You will get and error if you skip a field below.

Variable Text Fields
Warning: Check for typos, this info will be copied and pasted into your order.
Sample Text & Info:
*Return Address line 1:
1234 Liberty Lane
*Return address line 2:
Anytown, US 12345
*Signature Name:
Robert T. Smith -
*Legal Entity Name:
ABC Company, Inc. dba University Painters or Bob Smith dba University Painters
(for sole proprietors)
*State License Number:
MD MHIC #1234-6
(if you are not required to have this in your state please put the word "not required" in the field. If you leave it blank your order will not go through.

3. Total Mail sending this drop:*


4. Specific Amounts and Zip Codes
If you have different income levels for specific zip codes please leave special instructions in Additional Info area.

Amount sending: Zip Code:
Amount sending: Zip Code:

Amount sending: Zip Code:

Amount sending: Zip Code:

Amount sending: Zip Code:

Amount sending: Zip Code:

additional information

Please feel free to add any additional Comments or Questions in the space below:

feedback: It's important!
My goal is to make the ordering process as simple and efficient as possible while maintaining a high level of quality. Since this is a new (and important form) Please take the time to let me know if there is anything you would changed on this form to make the process of ordering better.
By submitting this order I acknowledge that I am ordering direct mail services from Cusick Marketing and agree to pay for what I have ordered above. I also understand that I am responsible for the accuracy of my order including the amounts and zip codes I order.
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