1. *First Name    *Last Name

2. Company:

3. *Mailing Addess:

4. *City       *State   *ZIP

                       sample phone no:  xxx-xxx-xxxx       

5. *Phone No:          6. FAX No.

7. *Email Address:(Include ENTIRE email address, ex:  JohnDoe@cybersol.com)

8. What type of industry are your representing?    Please select the best answer(s)

a) Restaurant Supplier

b) Restaurant                                 

c) Food Processing

d) Industrial Processing

e) Dairy Industry

f) Educational Institution

g) Retail

h) Wholesale

i) Arts & Crafts

j) Personal Use

k) Other (please specify)

9. What products would you like to see added to our web site?    

10. Additional comments: 

Your catalog should arrive in approximately 4-5 days.  

Click on the Request for Catalog button below to send your request to our Customer Service Department.

(800) 922-3124        -        (269) 621-3124      -      (269) 621-3127 FAX

14 S. Center St.     -      PO Box 86     -     Hartford, MI  49057