your company name:
........................................................................ (leave blank if you
don't have one)
your name:
.........................................................................................
your physical address:
....................................................................
your comments,
suggestions, requests and feedback
please:
1.the code of the first item that
you want: ..................................
the price of the first
item as displayed on
the web site: .........
2. the code of the
second item that
you want: .............
the price of the
2nd item..................................................
3. the code of the
third item that
you want: ...
the price of the
3rd item ....................................
your cell phone number:................................................................
your fax number:
............................................................................
your
email address:
.......................................................................
(its very important that
you make sure that this is correct otherwise we might not be able to
contact you)
website address:
.............................................................................
(leave blank if you don't
have one)
