Everything in BLUE  is required
Company
Client Name (Only if agency)
I.O. #
First Name
Last Name
Rep Number (Only if agency)
Phone
Extension
E-mail
Requested Date of All Broadcasts	00/00/00 (Format)
Broadcast Quantity
Broadcast Frequency
Do you require data files returned back to you?  The request for cleaned data is essentially the equivalent of a reverse append. Additional charge of $250 per file type or 50,000 records, or a maximum charge of $1,000 per million. Out out data on request at no additional charge.	Select Yes No The request for cleaned data is essentially the equivalent of a reverse append. Additional charge Per file may apply.
Specify what data files you require ? (Allow 5 days from completion of broadcast for data file delivery)	Select No Data File Required All Deliverable All Deliverable with Unsubscribes Unsubscribes Opens and Clicks Only Opens Clicks and Unsubscribes Only Hard Bounces Soft Bounces Hard and Soft Bounces All Data The request for cleaned data is essentially the equivalent of a reverse append. Additional charge Per file may apply.
Price Quoted ( Required for Agencies or Net Terms )	( Required for Agencies or Net Terms)
Targeted Audience - Specify Details (B2B specify SIC Code)	(If any)
From Line  #1      (2 max) As it appears to the left of the @ sign. No spaces between words.
From Line  #2
Subject Line  #1   (3 max)
Subject Line  #2
Subject Line  #3
Landing Page Link                                              http://www.
Test Email  #1    (1 required for testing and creative approval)
Test Email  #2    (All Test Emails are sent password protected)
Test Email  #3    (If more than 5 attach in MS Notepad)
Test Email  #4    The User Name and Password is   TEST
Test Email  #5
Seed  #1  5 max   (included in broadcast and our opt-in list)
Seed  #2                (All Seed Emails are sent password protected)
Seed  #3                 (If more than 5 attach in MS Notepad)
Seed  #4                The User Name and Password is  TEST
Seed  #5
We only accept .html or .txt creative's. We do not accept creative's built in Word , CSS or containing Java or Flash. If code contains Internal Tracking please note in "Special Instructions". Check each image link to insure the address contains the full domain name to call the each image.
HTML or TXT Creative Code (copy html or .txt code and paste) Or email .txt in MS Notepad separately and state emailed separately in this field) (email image jpg to fmiller@fmead.com )
HTML or TXT Creative Code (copy html or .txt code and paste)	(if additional)
HTML or TXT Creative Code (copy html or .txt code and paste)	(if additional)
HTML or TXT Creative Code (copy .html or .txt code and paste)	(if additional)
HTML or TXT Creative Code (copy html or .txt code and paste)	(if additional)
Creative Image Hosting Required?	Select Yes No (Image Hosting is not allowed for additional broadcasting by 3rd parties)
Tracking required ? 1 tracking report provided at no charge. $25 per additional tracking report	Select Yes No
Suppression File ?	Select Yes No (email suppression file to or  FTP to: www.frankmillerftp.com UN: frankftp    Call for password.
Any special Instructions including target audience. (if any)	(If any) Targeted, Internal Tracking Code, Image Hosting, ect
IF YOU DO NOT HAVE A SUPPRESSION LIST PLEASE READ. I/WE do not have a suppression list nor have I/WE have never had any requests by any person or company to be removed from further emailing for the products or services being offered by myself or the company that I represent for this email broadcast. I agree to release from liability and hold harmless The Miller Group, LLC its principals and affiliates from any liability that may arise from knowingly or unknowingly failing to provide a current accurate suppression list.
For All Agencies and Net Term Clients
All products including data sales, data appends, email broadcasts and all credit card purchases are final. Credit cards transactions waive any right to charge back for any product or service provided by, or on behalf of the Miller Group, LLC dba Frank Miller E-advertising. Returned checks are subject to a $35 NSF charge per return. Charge backs and past due accounts over 30 days are subject to a 18% annual interest rate charge, or the highest rate allowed by law, along with all cost of collection, legal fees and any and all additional costs incurred for the debt collection of the services provided. Past due accounts over 30 days delinquent from due date will be charged the entire retail value of all services provided including the full value of promotional or agency discounted services and products as listed on the retail pricing matrix within this website. Collection accounts may at the discretion of The Miller Group, LLC be reported to any or all credit reporting agencies. By your signature below you acknowledge that you personally guarantee both as an individual, and officer or authorized agent of your company the full payment of the products and services rendered as indicated in this Broadcast Order Form. Please refer to terms and conditions located at www.fmead.com and incorporated and referenced herein.
Authorized By (electronic signature)
Title or Rep #
Date