IMS List Management Services

PLEASE COMPLETE THE FOLLOWING INFORMATION. WHEN FINISHED, YOU WILL BE ABLE TO CHOOSE FROM A LIST OF AVAILABLE PRODUCTS AND SERVICES.

YOU WILL ALSO HAVE THE OPTION OF PAYING BY CHECK AND RECEIVING AN EMAIL WITH THE TERMS AND CONDITIONS AGREEMENTS, OR PAYING BY CREDIT CARD AND CLICKING THROUGH THE AGREEMENTS ON-LINE.

Fields marked with * are required.

PRIMARY CONTACT INFORMATION:

First Name*:
Last Name*:
Title:
Company*:
Address*:
Address 2:
City*:

A state is required for the following countries: United States and Canada.
State/Province:
Foreign State:
Zip/Postal Code*:
Country*:
Website :
Telephone*:    Extension
Fax:
Primary Contact Email*:
Verify Your Primary Contact Email*:

Please enter the e-mail address where you would prefer new file notices be sent. This includes all messages regarding uploading and downloading EMPS files for cleaning, as well as notification that new files have been posted to the site for downloading.
Email Notification*:
Verify Your Email Notification*:

BILLING INFORMATION:

Billing Information is the same as Primary Contact Information
First Name*:
Last Name*:
Title:
Company*:
Address*:
Address 2:
City*:

A state is required for the following countries: United States and Canada.
State/Province:
Foreign State:
Zip/Postal Code*:
Country*:
Telephone*:    Extension

Please enter the e-mail address where you would prefer subscription notices be sent. This includes renewal notices, forgotten passwords, and any other billing notices.
Billing Email*:
Verify Your Billing Email*:

OTHER INFORMATION:

Years company has
been in business*:
Dunns Number:
(optional)
ANA Member Company ID:
(If applicable)
Purchase Order Number:
(optional)

In order to provide you with the correct pricing for each product, please answer the following questions about your company.
Please Indicate your company's product or service*:

Please check one of the following*:
Service Provider: A service provider would be cleaning files for others. If you plan to pass the IMS List Management products against files belonging to others, you are a service provider.

End User: If you plan to pass the IMS List Management products against your own files, you are an end user.

Please tell us how you heard about us
INTERNET SEARCH ENGINE
DIRECT MAIL
REFERRAL
EMAIL
OTHER (Please indicate how you heard of us)