Dealer Order Form

Dealership Marketing Materials Information

Dealership Name (please input EXACT Dealership Name)

Website

Phone Number

Street

City

State

Zip Code

Sender "From" Name (if different than Dealership Name provided)

Dealership Contacts for Distribution Lists

	First Name	Last Name	Title	Email	Phone Number
Dealership Contact
Dealership Contact

If you have additional Dealership Contacts, please email LocaliQCCChanges@clientcommand.com with the same fields listed above

Targeted Market

What radius was presented in the Sales Process?

Target Zip Code

Comments Regarding Target Zip Code

*Radius will be measured from Dealership's zip code in details above unless otherwise noted in the Target Market.

Monthly Sales Average (New + Used)

DMS Information

DMS

Reynolds & Reynolds Information

Customer #

Store #

Branch #

DMS Other

Dealership DMS Contact (for DMS Assistance)

First Name

Last Name

Phone Number

LocaliQ Info

	First Name	Last Name	Email	Phone Number
Account Executive

LocaliQ Internal Information

Adpoint ID Number

Order ID Number

If you receive an error message from a field that requires an email address, please make sure to remove any spaces before or after the email address.