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List Rental Order Form

This is a one-time, one-use rental agreement. Please allow 2-3 weeks for order processing.

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Contact Details

Institution/Program(Required)

Name(Required)

First Last

Title

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email to send file(s) to(Required)

Enter Email Confirm Email

Choose which type of list you would like:(Required)

Member Email addresses

Member Postal Mailing addresses

To order Member Email addresses, please select one:

I am a Nonprofit College/University, School, or Program: $150 per single-use file

I am a For-Profit Institution or Company: $500 per single-use file

If you are a Nonprofit organization, select how many Excel files of Member Email addresses you would like to order:

$150 per single-use file

If you are a For-Profit organization, select how many Excel files of Member Email addresses you would like to order:

$500 per single-use file

Nonprofit Email List Subtotal

$0.00

For-Profit Email List Subtotal

$0.00

To order Member Postal Mailing addresses, the cost is $500 for a single-use file (for both Nonprofits and For-Profits). We cannot provide Postal lists for Therapeutic consultants. Select how many Excel files of Member Postal addresses you would like to order:

Member Postal Address List Subtotal

$0.00

My institution/program wants to connect with 51�Թ� consultants who advise students in this area(s):(Required)

K-12 Day/Boarding/Online School options

College/University options

Graduate/Professional School options

Therapeutic School/Program/RTC options

LD/ND School/Program options

Brief description of the intended use of this list:(Required)

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If paying by check, select this box and send payment within 10 days to "51�Թ� Mailing List," 3251 Blenheim Blvd., Suite 510, Fairfax, VA 22030. After you submit this form, you will receive an email confirmation that you can use as an invoice. The file will be sent after payment is received.

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Supported Credit Cards: American Express, Discover, MasterCard, Visa

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51�Թ� Member

51�Թ� has more than 2,800 skilled, ethical members ready to guide you through the process of finding, applying to, and selecting a right-fit college, school, or program.

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3251 Blenheim Blvd
Suite 510
Fairfax, Virginia 22030

Email: [email protected]
Phone: 703-552-9477

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List Rental Order Form

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