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E-Blast Order Form

Please fill out the form below to the best of your ability. If you have questions about anything being asked for, or would like help from one of our marketing professionals, please call 248-414-6860, or click the big orange button below. If we have suggestions or questions, we will be sure to contact you before getting started.

Contact Me First

Required Info

Name of person placing this request


Email address

Phone number

E-Blast Info

Requested Due Date:
All orders requiring a 5 business days or less turn-around time will incur a rush charge.

Subject Line

What logos/images are to be used?


Web Address

Business Address

Phone Number(s)

What Social Icons should be included?

If you selected "other", enter the icon name here

What is the special? Describe exact words to be used. Capitalization and
punctuation will be followed as directed.

Is there a call to action? If so, provide the link as well as any other links to website, social, etc.

When does this special start?

When does this special end?

Is this available at all locations?

If no, at what location(s) is it available?

Can this offer be combined with other coupons/offers, etc?

If yes, please list:

What is the expiration date?

Describe how this offer will be redeemed. Coupon code on E-blast? Mention this AD?
Show this email when ordering?

Is there a limit to this offer?

If yes, what is it?

Is this offer available for online ordering?

How many blasts would you like sent?

Email blast 1 date

Email blast 2 date

Email blast 3 date

Email blast 4 date

Is your email list in an excel format?

If yes, upload it here

Is there a targeted zip code?

If yes, what is it?

Will there be animations?

If yes, what kind of animation?

Will there be any banners?

If yes, what kind of banner?

If we have your list, which list is this going to?

New Client Information

Do we currently have your E-Blast account details on file?

If you answered No, do you need us to set an account up for you?

If you have an account, please provide the name of your E-Blast provider
along with the user name and password.

Please list any additional direction you were not able to provide above.

Logo & Media

Images to add, including headshots, company logo, affiliation logos, etc.
Please be sure artwork is high resolution (300 dpi) or in vector format.

This form has a TOTAL UPLOAD LIMIT of 8mb for file uploads.
If your files exceed that limit please use We Transfer
to send your zipped images to info@pgnagency.com

Upload Hi-res / Vector Logo - .ai, .eps, .svg, .pdf format

Upload Zipped image files

Enter the code in the space provided: captcha

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