Illinois Mutual Supply Materials

Personalized Materials

Your Name

First Name

Last Name

When?

Must Arrive at Location By

Who and Where?

Agent Name

Agent Code

Agent Email

Agent Phone

Ship To

Shipping Address

City

State

Zip Code

Special Shipping Instructions

Is this for an Organization or Association? a choice

Has this Organization been approved

Existing Piece

Type of Piece

Form Number

Printed or Electronic?

Quantity

Personalized Information

Proof Requested?

Anything Else?

New Piece/Special Event

Printed or Electronic?

Quantity

What product line is this for?

What type of piece do you need?

If other, explain the piece you would like created

Who will receive this piece?

If Other, who will receive this piece?

Marketing Message

What do you want them to do when they get this piece?

If other, what do you want them to do when they get this piece?

Special required disclaimers from requesting party:

Personalization Information

Proof Requested?

Anything Else?

Attach any logo needed here:

Agency Meetings

Your Name

First Name

Last Name

When?

Must Arrive at Location by

Pick Up in Supply On

Who and Where?

Send To

Address

City

State

Zip Code

ATTN

Special Shipping Instructions

What

Kit Type

Kit Region

Kit Quantity

Special Instructions for Kits

Additional Forms Needed and Quantity

Pen Quantity

Merchandise

Merchandise Item #1

Quantity

Merchandise Item #2

Quantity

Special Request for Merchandise

Anything Else?

Lunch and Learns

Your Name

First Name

Last Name

When?

Must Arrive at Location by

Pick Up in Supply On

Who and Where?

Send To

Address

City

State

Zip Code

ATTN

Special Shipping Instructions

What

Kit Type

Kit Region

Kit Quantity

Special Instructions for Kits

Additional Forms Needed

Pen Quantity

Banner #1

Banner #2

Merchandise

Merchandise Item #1

Quantity

Merchandise Item #2

Quantity

Special Requests for Merchandise

Anything Else

Anything Else?

Tradeshows

Your Name

First Name

Last Name

When?

Must Arrive at Location by

Who and Where?

Location

Address

City

State

Zip Code

ATTN

Special Shipping Instructions

What

Tablecloth (Regionals should have their own)

Banners

Pen Quantity

M.U.G. Mug Quantity

Acrylic Mug Quantity

Merchandise

Merchandise Item #1

Quantity

Merchandise Item #2

Quantity

Flyer Quantities

Fast Start - Life

DI Incentive

Life Incentive

M.U.G. Flyer - C9585

Additional Flyer & Quantities

Anything Else?

Anything Elese?

Other

Your Name

First Name

Last Name

Other Request

Agent Name

Agent Code

Address

City

State

Zip Code

ATTN

How can we help?

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Illinois Mutual Supply Materials

Your Name

When?

Who and Where?

Existing Piece

New Piece/Special Event

Your Name

When?

Who and Where?

What

Merchandise

Anything Else?

Your Name

When?

Who and Where?

What

Merchandise

Anything Else

Your Name

When?

Who and Where?

What

Merchandise

Flyer Quantities

Anything Else?

Your Name

Other Request

Contact Illinois Mutual

Life Insurance

Disability Insurance

Worksite Insurance

Work with Illinois Mutual