Fax Inquiry Form

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PLEASE PRINT OUT PAGE AND FAX BACK TO US. PHOTO COPY FOR FUTURE USE.

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FAX NUMBER: 812-768-6213

YOUR COMPANY _______________________YOUR NAME ________________TITLE_________

STREET _______________________CITY________________ STATE _______ ZIP________

YOUR PHONE NO. _____-_____-______ EXT_____________

YOUR FAX NO. _____-_____-_______ 

Please tell us about your company: _________________________________________

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Please check areas you would like more information:
    
       ____ Selective Adhesive Applications 
       ____ Membrane Switch Spacers
       ____ Foam & Rubber
       ____ Electrical Insulation Components
       ____ EMI RFI Shielding
       ____ Custom Lamination



Additional Comments:________________________________________________________ 
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R.R.#2 Box 105B
Haubstadt, IN 47639
Phone: 812-768-6730
Watts: 800-467-6730
Fax: 812-768-6213

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