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Just complete this form and Click on Submit when ready to send

* For Radio Stations, Legitimate Music Reviewers and TOP DJs Only *

We are thrilled that you are interested in receiving some of our free promotional products. In the pursuit to give the public what they want, there is some information that we would like you to provide us. Providing us with this info will give us an accurate view of the demographics in your town and helps us to help you. Some of the information can be found in your Phone book. After receiving your PROMO REQUEST FORM and your information verified, we will start mailing you our latest material. Our mailing campaign takes place every 3-4 months.

* NOTE * material will not be sent if at least three Record Stores and their telephone numbers are not provided. All information will also be checked for legitimacy.

Your name:
Your Title:
Phone/Pager:
E-mail:
Street Address:
City:
State/Province:
Zip Code:
Country:
Web Site URL:
Club, Venue or Co. name:
Radio Station Name
Program Director Name:
Station Address:
City:
State/Province
Zip Code:
Type of Music Requesting:
Format Requesting? Mp3, 7", 12", CD etc.

Promoters in your area:

Clubs, Hot spots, Festival, Demographics.

Stores in your area that sells the type of Music that you are requesting::

Name	Address	Phone #

Comments:

Thanks for visiting our Web Site!

Your comments are appreciated!

Your name:

Your Title:

Phone/Pager:

E-mail:

Street Address:

City:

State/Province:

Zip Code:

Country:

Web Site URL:

Club, Venue or Co. name:

Radio Station Name

Program Director Name:

Station Address:

City:

State/Province

Zip Code:

Type of Music Requesting:

Format Requesting? Mp3, 7", 12", CD etc.

Promoters in your area:

Clubs, Hot spots, Festival, Demographics.

Stores in your area that sells the type of Music that you are requesting::