GoResponse Info Pack Request

1. Please can I take your First name, Surname and Title please?

First Name/Initial *

Last Name *

Title

2. Please can I take your full address including the house name or number and postcode? Please confirm the full address back to the customer

House Name or Number *

Street name

Address Line 2

Postcode *

3. Please can I take your telephone number?

Please confirm the telephone number back to the customer

Telephone Number *

4. Do you have a code to quote to me from the advert please? It's usually printed on the coupon.

Yes

Tick this box if customer HAS a code

Tick this box if customer doesn't have the code

5. What's the code from the coupon please?
*

5. Could I take the name of the paper or magazine the advert was in please? *

6. Which information pack would you like me to send?

Smartphones

Tablets

Any notes (NOT compulsory to complete)

Thank you - I'll pop the free info pack in the post to you.

Please press the "Submit" button to send over the details to The Helpful Book Company.