Special Mailing Request Form
Required *
Date:
*
-
Month
-
Day
Year
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Hour Minutes
AM
PM
AM/PM Option
Name:
*
First Name
Last Name
Email:
*
Phone Extension:
*
Title of Mailing:
*
Estimated Volume:
*
Budget Center:
*
Date Material Delivered to the Mailroom:
*
-
Month
-
Day
Year
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Due Date for Mailing:
*
-
Month
-
Day
Year
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Address Information
Address provided by:
Labels (Please Attach)
Electronic/Disk
List (Agent Numbers)
List (Agent Numbers)
*
Independent Agents
Career Agents
All Active Agents
Services
Service(s) Requested:
Label
Fold
Insert
Assemble
Match (If more than one copy)
Number of Inserts:
*
Leftover Supplies
Leftover Handling:
Return to Requestor
Destroy
To Supply Dept.
Employee Distribution Group
Select employee distribution group:
Home Office Employees
Branch Employees (CA, GA, IN, TX)
RVPs, SDs
Resident Adjusters
Other
If Other, describe:
*
Postage
Postage type:
1st Class/Presort
Standard (Reduce Postage with Restrictions. Contact Mail Services)
Other
Non Deliverable Mail
Non Deliverable/Return Mail:
Return to Mail Station
Destroy
Other
Return to Mail Station:
*
Scanning
Scanning Type:
Corporate Image
Commercial Image
For scanning jobs, please contact:
Corporate Image - Ext. 5025
Commercial Image - Ext. 5450
Special Instructions
List any special instructions here:
Print Form
Submit
Clear Form
Should be Empty: