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<td valign="top">Our application engineers and customer service representatives are here to assist you.<P>If you require an immediate response, please call us at 1-800-833-4237. If you do not require an immediate response, how would you like us to respond to you?<BR>
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<input type=checkbox name=respond_by_Email value="YES" tabindex="1"> Email
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<input type=checkbox name=respond_by_Fax value="YES" tabindex="2"> Fax
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<input type=checkbox name=respond_by_Phone value="YES" tabindex="3"> Phone
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<input type=checkbox name=respond_by_Postal value="YES" tabindex="4"> Postal
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<P>Will purchase within:<BR>
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<input type=checkbox name=purchase_within_3_months value="YES" tabindex="5"> 3 months
</TD>
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<input type=checkbox name=purchase_within_6_months value="YES" tabindex="6"> 6 months
</TD>
<TD>
<input type=checkbox name=purchase_within_1_year value="YES" tabindex="7"> 1 year
</TD>
<TD>
<input type=checkbox name=purchase_within_None value="YES" tabindex="8"> None
</TD>
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Other: <input size=10 type=text name=purchase_within_Other tabindex="9">
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My company business type is:
</TD>
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</TD>
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<TD COLSPAN=2>
</TD>
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<TD>
My product interest is:
</TD>
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</TD>
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<input type=checkbox name='Send info regarding product interest' value="YES" tabindex="12"> Only send information regarding product interest.<BR>
<input type=checkbox name='Send Product Selection Guide' value="YES" tabindex="13"> Please send Product Selection Guide.</P>
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My application is:<BR>
<TEXTAREA ROWS=5 COLS=52 NAME="Application" tabindex="16"></TEXTAREA>
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Questions/Comments:<BR>
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Please fill in the blocks below. If your browser does not support forms, please email this information to
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<TD>Name: </TD>
<TD><input size=42 type=text name=Name tabindex="18"></TD>
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<TR>
<TD>Title: </TD>
<TD><input size=42 type=text name=Title tabindex="19"></TD>
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<TR>
<TD>Company: </TD>
<TD><input size=42 type=text name=Company tabindex="20"></TD>
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<TD>Address 1: </TD>
<TD><input size=42 type=text name=Address1 tabindex="21"></TD>
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<TD>Address 2: </TD>
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<TR>
<TD>City: </TD>
<TD><input size=42 type=text name=City tabindex="23"></TD>
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<TR>
<TD>State/Province: </TD>
<TD><input size=42 type=text name=State_Province tabindex="24"></TD>
</TR>
<TR>
<TD>Postal Code: </TD>
<TD><input size=42 type=text name=Postal_Code tabindex="25"></TD>
</TR>
<TR>
<TD>Country: </TD>
<TD><input size=42 type=text name=Country tabindex="26"></TD>
</TR>
<TR>
<TD>Phone: </TD>
<TD><input size=42 type=text name=Phone tabindex="27"></TD>
</TR>
<TR>
<TD>Fax: </TD>
<TD><input size=42 type=text name=Fax tabindex="28"></TD>
</TR>
<TR>
<TD>Email: </TD>
<TD><input size=42 type=text name=email tabindex="29"></TD>
</TR>
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<p> <input type="submit" value="Submit" name="B1"><input type="reset" value="Reset" name="B2"></p>
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<td width="456">
<p align="center">|<a href="../Pro/product.htm">Product</a>|<a href="../Manuals/Oper_Manuals.htm">Operation
Manuals</a>|<a href="../Pro/Technical%20Notes.htm">Technical Notes</a>|<a href="../News/Press_Release.htm">Press Releases</a>|<a href="../TRSHWS/Trd_Shows.htm">Trade Shows</a>|<br>
|<a href="../Rep/Reps.htm">Sales Offices</a>|<a href="../service_repairs.htm">Service/Repairs</a>|<br>
<br>
|<a href="../Index.htm">Home</a>|<a href="../Site_Map/Site_Map.htm">Site
Map</a>|<a href="../About_Us.htm">About
Us</a>|<a href="../Condolan/Contact1.htm">Contact Us</a>|<a href="../EMP/emplymnt.htm">Employment</a>|<a href="../Search.htm">Search</a>|<br>
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<p align="center"><b><font color="#003399" size="4">Dolan-Jenner Industries</font></b><br>
<font size="2">159 Swanson Road; Boxborough, MA 01719<br>
Toll Free: (800) 833-4237; Fax: (978) 264-0292</font></td>
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