12 MONTH MARKETING PROGRAM
ORDER FORM

Please complete the form below to enroll in the 12 Month Marketing Program. After receiving your enrollment confirmation, a member of our team will contact you for your credit card information. If you have any questions when completing this form, please contact Customer Service at 1-800-243-5334 or customerservice@ltmclientmarketing.com.

First name:*

Last name:*

Designation(s):

License#:
(AR or CA only)

Prudential Approved Title:

Firm / Region:

Address:*

City:*

State:*

Zip:*

Phone1:*
(Mobile)

Phone 2:
(Business)

Fax:

E-mail:*

Website:

Number of Recipients:*

Estimated Monthly Cost:

Attachments:* Please include photos, recipient lists, and business cards. Prudential's approved logo is on file. Photos should be at least 3"x4" at 300dpi, high resolution. Upload single files one at a time or upload multiple files at once.

Click "+" for more files

Are you including additional financial professionals or a marketing assistant on your communications?
If you select "Yes", please include additional names/titles in the "Comments/Notes" field below.

Yes

Comments / Notes:

I have read and I consent to the below Limitation of Liability.

LIMITATION OF LIABILITY: LTM Marketing Specialists LLC (“LTM”) sole liability to the customer or any third party for claims, notwithstanding the forms of such claims, for any error or omission in the service, or late delivery or unavailability of the services, shall be to correct the error and provide the services as promptly as possible. In no event will LTM be responsible for special, indirect, incidental or consequential damages which the customer may incur or experience on account of entering into or relying on this agreement. The customer hereby releases and forever discharges LTM for any and all action, claims, demands, costs, expenses and compensation whatsoever, in connection with the foregoing.

I understand that I will receive proofs of each touch point to review and approve as part of the onboarding process for the program. I will provide LTM my credit card information securely upon request after enrollment, and understand my credit card will be charged monthly. Charges to my card will appear as LTM Marketing Specialists.

This authorization is to remain in effect until LTM has received written notification of termination from me in such time and in such manner as to afford LTM a reasonable opportunity to cancel my order in a timely and favorable fashion.

12 MONTH MARKETING PROGRAM ORDER FORM

12 MONTH MARKETING PROGRAM
ORDER FORM