ExactTarget Order Form

Required Field Required fields:

Contact Information

















Select ExactTarget Services

Everything below, is a agency requirement. So the agencies that wants the additional information when invoiced will supply it.



Initial term Renewal term Upsell


Package Selection:


Email Selection

Pay-as-you-go Email

Bulk Email Purchase

# of Emails

per email rate

Feature / Service ExactTarget SKU Annual Price
Comments
Feature / Service ExactTarget SKU Annual Price
Comments
Feature / Service ExactTarget SKU Annual Price
Comments
Feature / Service ExactTarget SKU Annual Price
Comments
Feature / Service ExactTarget SKU Annual Price
Comments
Feature / Service ExactTarget SKU Annual Price
Comments
Feature / Service ExactTarget SKU Annual Price
Comments
Feature / Service ExactTarget SKU Annual Price
Comments
Feature / Service ExactTarget SKU Annual Price
Comments
Feature / Service ExactTarget SKU Annual Price
Comments
Feature / Service ExactTarget SKU Annual Price
Comments
Feature / Service ExactTarget SKU Annual Price
Comments
Feature / Service ExactTarget SKU Annual Price
Comments
Feature / Service ExactTarget SKU Annual Price
Comments
Feature / Service ExactTarget SKU Annual Price
Comments

Agency Billing Information















Special Billing Instructions (If Any):

(if required):

If using project the following are required:



Other codes that may be required by agency:







Other Information


Required Field