LocaliQ - Aftermarket Retail Modification / Cancel Change Order Form
Retail Modification or Cancellation Change Order
Existing
Marketing Materials Information
Company Name (please input EXACT Company Name)
Website
Phone Number
Street
City
State
Zip Code
Campaign Information
Please Select
Modify Existing Campaign
Cancel Existing Campaign
Requested Modifcation Date
Requested
Cancellation
Date
Reason for Cancellation
Which Product is being modified or cancelled?
Service
Parts
Both
Select Service Options Changing
Please select...
All
Auto Recalls
Auto Rental
Auto Repair
Detailing
Diagnostic
Select Parts Options Changing
Please select...
All
Air Filters
Air Flow Sensor
Air Intake
Alternators
Auto Body
Do you want to send additional email?
Boost (new creative, new list & deployment)
3rd Email (sent to existing number of prospects)
2 Additional Deployments (sent to existing number of prospects)
Are the additional email deployments for this month one time or ongoing?
One Time
Ongoing
If ongoing, please input the number of months or continues for the remainder of contract.
Will these records be used in a Direct Mail campaign?
Yes
No
Select New Number of Records
Please select...
Audience Records 10k
Audience Records 15k
Audience Records 20k
Audience Records 22.5K
Audience Records 25k
Audience Records 30k
Audience Records 35k
Audience Records 40k
Audience Records 45k
Audience Records 50k
Changes to targeted Zip Code
Changes to multiple zip code target areas
Changes to radius
Please select...
5 Mile
10 Mile
20 Mile
30 Mile
Other (add miles needed in comment field below)
Additional Comments or Information
*If changes to target radius is changing for multiple zip codes, please add this information to the file upload
LocaliQ Sales Team
First Name
Last Name
Email
Phone Number
Account Executive
Sales Leader
Post Sales Leader
Client Success Manager
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.
LocaliQ Internal Information
Adpoint ID Number
Contact Information