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e-campaign request form
Symbiosys Pty Limited
Unit 134, 117 0ld Pittwater Road,
Brookvale NSW 2100
P +61 2 9007 9878
F +61 2 9907 4922

E-CAMPAIGN REQUST FORM

So we can broadcast your e-campaigns on your behalf, you must fill out this form, agree to the conditions and authorise us to do so.
All the fields with an * asterisk are required.

Your Contact Information

Company Name:
*
Authorised Contact:
*
Contact Email:
*
Contact Phone:
*

Campaign Details
Campaign Name:
*
Subject Line:
*
From Email Address:
*
From Senders Name:
*
Date to be Sent:
*

Notes

Any other details?

Upload Recipient List

Security Validation

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  • Text is case sensitive
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Authorisation
I confirm that all email addresses supplied to Symbiosys to be recipients of this
campaign have been lawfully obtained and can legally be sent emails under the current
Australian Privacy and Spam Guidlines.


© Symbiosys Pty Limited 2007