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EASY-TO-MAIL/PHONE/FAX Form

140 Quamina Street,

South Cummingsburg,

Georgetown,

 Guyana 

Tel:    592-225-2387, 592-227-5095  

Fax:    592-225-0417

E-mail:    kojac_mkt@hotmail.com

Please provide the following contact information:

First Name
Last Name
Title
Organization
Street Address
City
State/Province (optional)
Zip/Postal Code (optional)
Country
Work Phone
Home Phone
FAX
E-mail
URL

Please provide the following product information:

Product Name
SKU Number
ORDER ITEMS HERE   (For faster phone service, please complete this section before you call in with your order.)
SKU QTY DESCRIPTION

 

Bill To:   (If name or address is missing please write in or indicate changes across.)

BILLING
Purchase Order #
Account Name

 

SHIPPING
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country

Choose one of the following payment options:



IF THIS IS YOUR FIRST ORDER...
 We'll be glad to establish a business account for open credit purchases.  Then, just pay our invoices within 14 or 30 days.  Satisfactory rating with our Accounts Department establishes your credit account.  If not rated, your advance payment will permit prompt delivery of your first order.

Would you like us to inform you of updates in our product and service categories?

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How would you rate your opinion of our website and our service?


Would you like to make any suggestions or recommendations?


 

Note:  Every effort is made for our Price List to be totally accurate.  However, an occasional printing error may occur.  Therefore, we reserve the right to bill at corrected prices. 

Copyright 2000
KOJAC Marketing Agency
All rights reserved

Thank you for your Order!

If you would like us to send one of your friends a copy of our price list, please fill in the information below.  

Name:

Email address:

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