Request FREE Copies

If your business or organization would like to request FREE copies for distribution to your 60+ members or clients, please fill out the form below or fax your request on letterhead to 412-278-4906.

Fields marked with an * indicate required information.

Name:
Position/Job Title:
* Business/Organization:
* Address:	(No P.O. Boxes, please.)
* City:
* State:
* ZIP code:
* Phone:
Fax:
Email:
Are you interested in receiving advertising information? Yes No
How many copies would you like to order at no cost?
* *Would you like to receive the same number of copies every six (6) months* ("autoship")?** Yes No
* Generally, how will you be distributing this guide to older adults?
Please list any other businesses or organizations you feel might be interested in the Senior Citizen's Guide:
No information submitted through this form will be given out or sold.