THE VINTAGE COMPANY

REQUEST FOR INFORMATION FORM


This is a REQUEST FOR INFORMATION form for The Vintage Co products. After you submit this form, we will send you all information we have on product availablity and prices.

Please provide the following contact information:

Name
Title
Organization
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
Home Phone
FAX
E-mail
URL

Please provide the following product information:

Product name
Description
Price Range

If this is an order, please provide the following ordering information:

QTY DESCRIPTION
  BILLING
Purchase order or Check#
Account name
  SHIPPING
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country

Please identify and describe yourself:

Name
Date of birth
Sex Male Female


Copyrighted BcompS.
Last revised: May 26, 1999