Step 1 – Custom Email Leads

Please complete the following form to customize your Email Leads:

The Name of the Company You Are Promoting:

Your Full Name:

Email for Lead Delivery:

Phone Number: (If this is your first time ordering with us, you will be called to confirm your order. Leads will not be delivered without a valid phone number)

Website Address : (Please type in your website. A company self-replicated website or your personal website is acceptable. Email leads cannot be delivered without a valid website.)

Choose Domain Names to Filter:

Domain Filtering Policies:

You can check up to 5 boxes below to filter out the domains of your choice.
If you check Yahoo.com as one of the domains to filter out, you may only check one other box, for a total of 2 boxes checked.
Place a check in the box to the left of the domains you wish to have filtered out. If you do not see the domain you would like filtered out, you can add it to the comments box below.

Yahoo.com	AOL.com	MSN.com	Hotmail.com	Gmail.com
CS.com	SBCGlobal.net	Juno.com	All Netscape domains
Verizon.net	Earthlink.net	ATT.net	Comcast.net
Cox.net	Bellsouth.net	Charter.net	All Road Runner domains
All .mil, .edu, and .gov domains		Other domains (type in the box below)

Comments or Other Domains:

We hate spam as much as you do.
Your information is private and confidential and will not be sold to any other party.