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  1. Company :
    Name :

  2. Address :
    Tel :
    FAX :
    E-Mail Address :
    URL :

  3. Type of Business
    Chain Store
    Dept. Store
    Sales Agent

  4. Information Requested
    Photo Offer for : Photo Frame Clock Others

  5. Estimated Ordering Amount
    U. S. Dollars/Year
    U. S. Dollars/Shipment

  6. Memo for other requests: