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Package Request

To request a package, fill out the form below. All required fields must have valid values. In order to make our program work, we must enforce the following rules:

  1. You must read the Disclaimer and Support pages before reqesting any package.
  2. We will only comply with requests from residents of the U. S. (50 states only, no territories).
  3. We reserve the right to refuse to send the package to any person without providing a reason.

Once you press the submit button and all the fields are valid, a confirmation page will be displayed. Your package will be mailed to you at our earliest convenience..


Fill out the information shown below. Fields in bold are required.

First/Last Name :
HomePhone: (972-333-5555) Cell Phone: (972-333-5555 or 972-333-5555x1234)
Email address: (name@domainname.com)
Street 1:
Street 2:
City:
State: Zip Code: (US 12345 or 12345-1234)
Package Requested:
Do you accept the terms
of this agreement?
(yes)