Home Services Modification/Cancel Form
Existing Marketing Materials Information
Company Name (please input EXACT Company Name)
Website
Phone Number
12 characters left.
Street
City
State
2 characters left.
Zip Code
5 characters left.
If you have additional Contacts, please email
LocaliQCCChanges@clientcommand.com
with the same fields listed above
Campaign Information
Please Select
Modify Existing Campaign
Cancel Existing Campaign
Please fill the date in MM/DD/YYYY format
Effective Date for Mod/Canellation
Please fill the date in MM/DD/YYYY format
Select to modify number of Sales Records
Please select...
Sales Data Records 5k
Sales Data Records 7K
Sales Data Records 10k
Sales Data Records 15k
Sales Data Records 20k
Sales Data Records 22.5k
Sales Data Records 25k
Sales Data Records 30k
Sales Data Records 35k
Sales Data Records 40k
Sales Data Records 45k
Sales Data Records 50k
Sales Data Records 55k + (input the number of records in the appropriate field)
Please enter the number of
Sales Data Records
needed if over 55k
Targeted Market
Are you changing your Target Area?
Target Radius (number of miles)
Customized (multiple zip codes to be included)
Both
Change to last seen Online Activity Days?
30 Days
60 Days
90 Days
120 Days
Target Zip Code
5 characters left.
What radius from target zip code entered?
Please select...
10 Mile
20 Mile
30 Mile
Other
Please list miles from Target Zip Code
5 characters left.
Comments Regarding Target Zip Code
File Upload
LocaliQ Info
First & Last Name
Email
Phone Number
Account Executive
12 characters left.
Sales Manager
Client Success Manager
LocaliQ Internal Information
Adpoint ID Number
Order ID Number
If you receive an error message from a field that requires an email address, please make sure to remove any spaces before or after the email address.
Contact Information