Ceridian Email Information Submission Form

Email Broadcast Request Form

	Your Information: (All these fields are required)
Your Name:
Your Email Address:
Your Phone Number:
Type of Email (select one):	Email Information: (All these fields are required)
Type of Email (select one):	Marcomm Communications (use for all requests under Keith Peterson's PO: Connection Newsletters, CeridianVoice, INSIGHTS, Year-end Compass Newsletters, etc.)

	Operational Communications (use for all requests under Keith Peterson's PO: Compliance Alerts, Product Updates, etc.)
	Other Click here for more information on Ceridian Email Project Guidelines
From Name:
From/Reply-to Email Address:
Subject Line:
Send Date:
Email Address List:
Email Message:
Optional Files:	Optional: If you have additional files to upload
Optional Files:
Additional Instructions:
	Please allow 2-3 business days to process your request. Thank you. If you have technical questions or questions about using this form please contact support@email-upload.com