SCULists Market Segment FAX Selection Form

This form outlines the information you will need when placing an order.  To help save time simply print this screen then fill in the information below and keep the form handy when calling or fax it to us. Our sales representives will use this information to help pin-point your target market. 

FAX 914-273-6617

Name:

 

Address:

 

City, State, Zip

 

Phone:

 

Location

Cities

Counties

Zip Codes

Income Bracket

$20K+

$30K+

$40K+

$50K+

$75K+

$100K+

Age Bracket

18-24

50-54

25-34

55-64

35-39

65+

40-50

other

Demographic Specifics

Gender:

M

F

Couples

Telephone

Homeowners

FAX 914-273-6617

Senior Citizens Unlimited, Inc.
 200 Business Park Drive, Suite 310, Armonk, NY 10504