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FAX

Aegis Marketing, Inc.
Instructions: To print out this fax form, on the 1515 Michigan St.
browser menu,  select File - Print. Grand Rapids, MI 46503
Fax: (616) 459-9969
Date: __________________________   
Please indicate your request ...
Name/Title: __________________________    [ ] Send us your brochure
Company Name: __________________________    [ ] Have a sales representative contact me
Address: __________________________    [ ] Call me to discuss my project
City/State/Zip: __________________________   
We are interested in ...
Phone: __________________________    [ ] Conducting customer/market satisfaction research
Fax: __________________________    [ ] Assessing market opportunities
[ ] Measuring advertising campaigns
Subject: __________________________    [ ] Understanding the buying process
[ ] Evaluating & defining foreign markets
Comments: __________________________    [ ] Acquisition (due diligence) research
[ ] Competitive intelligence gathering
[ ] Strategic evaluation & planning
[ ] Telemarketing (name searches, etc.)
[ ] Direct marketing (database compilation)
[ ] Other: ________________________
The above information will help us better serve you. Thank you for your assistance!