Reverse Mortgage Crowds ORDER FORM



Please fill out this form completely and click the SUBMIT button at the bottom of the form. We will review your order and contact you to confirm your selections and mailing list criteria.  If you have any questions call 1-800-604-6535.

"* " denotes the field is Required


Contact Information:

Who will make the actual presentation?
Normally someone with credentials (e.g. "CLU")
  *Contact: Who takes care of clerical details like reviewing proof?
FMO/Parent Company:    *
  * Alternate phone:
  *      *
  * Fax:
Contact Preference (For sending proofs approvals, zip counts, etc.): 
seminar or appointment? Note: if you choose appointment, ignore seminar date, location options below.
Seminar and Proof Information:
  *      *   
  * Mailer Type: Color Options:
Seminar Title:
  * Where shall the text of the card come from?

Template Number
Calif. License #:
Seminar Event Date(s)
If your mailer includes specific event dates, please fill out the fields below. We will confirm  your information before printing your postcards.
Seminar Event # 1 Seminar Event # 2
Restaurant Name: Restaurant Name:
Day of Week:  Date:   Day of Week:  Date:  
   Start Time:      Start Time:
Event Type: Event Type:
Seating Capacity: Seating Capacity:
Seminar Event # 3 Seminar Event # 4
Restaurant Name: Restaurant Name:
Day of Week:  Date:   Day of Week:  Date:  
   Start Time:    Start Time:
Event Type: Event Type:
Seating Capacity: Seating Capacity:
Restaurant Info
(Please avoid hotels, country clubs, and lower-end restaurants – our experience is that these locations usually produce poor responses)
Restaurant # 1 Restaurant # 2
Restaurant Name: Restaurant Name:
Address: Address:
City: City:
State: State:
Zip: Zip:
Phone: Phone:
RSVP Information
  *  Toll free number setup



Demographic and ZIP code criteria
  * Recommended: 55+
Recommended: ALL INCOMES
Note Using an income filter such as $25K and up eliminates customers with high assets but low income, e.g. widows
Single Family Dwelling Unit-increases probability of being a homeowner. Recommend using 5 years+ at same dwelling.
add $0.015 to price per piece (based on actual mortgage data)
add $0.02 to price per piece
add $0.02 to price per piece
add $0.02 to price per piece
Eliminate the following: (Remember, many people own apartments and condos)
Zip Codes: Pull names from these zip codes:
  * 8th zip code:
2nd zip code: 9th zip code:
3rd zip code: 10th zip code:
4th zip code: 11th zip code:
5th zip code: 12th zip code:
6th zip code: 13th zip code:
7th zip code: 14th zip code:
   * Which order shall we pull addresses from the zip codes above?
Payment Information
Please do NOT send payment until you receive your invoice from
  * Send Invoice to: eMail address:
   *  Payment Method

Special Instructions: If there are any special requests, instructions or questions you would like to add, please use the form below. We will contact you with the answers.
READY TO PLACE YOUR ORDER? Please review your order. You can edit any field or you can click the RESET button to start over. Once you have completed the order, click SUBMIT. One of our Customer Account Representatives will contact you to review and confirm your order.

Read before agreeing below:

I agree to not duplicate this Mailing Program in any manner, as it is protected under intellectual property rights © Reverse Mortgage Crowds! Inc. (RMCI), 2004. I authorize RMCI to print my invitations and submit them within 1-2 business days of my estimated mail date to the USPS for delivery. I acknowledge and agree that RMCI does not guarantee response rates, results, or delivery by the USPS. I will not hold RMCI liable for mail which is delayed due my lack of payment, my lack of written approvals, or the inability of the USPS to deliver the mail for any reason including weather related delays.  We suggest you add extra time to your mail date during the winter months.  The mailing lists utilized by RMCI are acquired from third parties that used their best efforts to meet your selected criteria.  No assurance can be given that the list or specific criteria you have chosen for your mailing will be completely accurate.

Laws governing the content of advertising material vary from state to state. Also if you are affiliated with a NASD/FINRA member firm you may be required to meet NASD/FINRA regulations regarding the content of your mailers. It is your obligation to ensure that your mailer/invitation is in full compliance with all applicable state and federal laws, rules and regulations. Reverse Mortgage Crowds Inc. (RMCI) assumes no responsibility for the content of your mailer or compliance with applicable laws. Any forms, templates or suggestions provided by RMCI are for convenience only and it is the mailers’ responsibility to ensure that his or her mailer fully complies with applicable law. I agree that RMCI shall not be responsible for any consequential damages. In no event shall RMCI’s damages with respect to any individual mailings exceed the amount paid to RMCI for such mailings.

This application is made at Fairfield, IA. The parties agree that all disputes shall be governed by Iowa law and consent to the exclusive jurisdiction, venue and forum of any state or federal court in Jefferson County Iowa.  Reverse Mortgage Crowds shall be entitled to recover its reasonable attorney fees in any action to collect any unpaid invoices.

     * Agreement
1100 N 4th | Fairfield, Iowa 52556 | Ph 1-641-209-6535