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REQUEST COUNTS
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Name
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1) CRITERIA

Enter all the criteria you want to target (i.e. age, income, dwelling type, etc...)
Enter the age or Date of Birth range you want to target. (i.e. 64-75)
Enter the estimated household income range to target (i.e. Under $20K or $50K+)
All dwelling types are selected unless you select otherwise.
Phones
List other criteria you want to target that is not listed on this form

2) GEOGRAPHY

Separate by commas
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