McGruff Child Safety Kit Leads

First Name *

Last Name *

Phone *

Email *

Address *

City *

State *

Postal code *

McGruff Leads - Month Requested *

McGruff Leads - Date Requested *

McGruff Leads - Number of Kits *

Passcode *

DELAY START - Only 25-30 leads should be entered on a SINGLE DATE. Choose Delay Start to schedule when all leads above 25-30 should be added into the system for initial contact. Recommended to not add more than 25-30 on any one UNIQUE START DATE.

DELAY START DATE - This is ONLY used when DELAY START is chosen for more than 25-30 initial leads. It is recommended to have NO MORE than 25-30 new leads added to any UNIQUE START DATE.

Date Lead Received *