Information Request Form To enable a timely response, ensure that all information specified is correct. The fields marked with * are required   * Company * First Name * Last Name Title / Position * Address * City   * State/Province   *Zip  *Country ---------------------- United States Andorra United Arab Emirates Afghanistan Antigua And Barbuda Anguilla Albania Armenia Netherlands Antilles Angola Antarctica Argentina American Samoa Austria Australia Aruba Azerbaijan Bosnia and Herzegovina Barbados Bangladesh Belgium Burkina Faso Bulgaria Bahrain Burundi Benin Bermuda Brunei Bolivia Brazil Bahamas, The Bhutan Bouvet Island Botswana Belarus Belize Canada Cocos (Keeling) Islands Congo, Democractic Republic of the Central African Republic Congo Switzerland Cote D'Ivoire (Ivory Coast) Cook Islands Chile Cameroon China Colombia Costa Rica Cuba Cape Verde Christmas Island Cyprus Czech Republic Germany Djibouti Denmark Dominica Dominican Republic Algeria Ecuador Estonia Egypt Eritrea Spain Ethiopia Finland Fiji Islands Falkland Islands (Islas Malvinas) Micronesia Faroe Islands France Gabon Grenada Georgia French Guiana Ghana Gibraltar Greenland Gambia, The Guinea Guadeloupe Equatorial Guinea Greece South Georgia And The South Sandwich Islands Guatemala Guam Guinea-Bissau Guyana Hong Kong S.A.R. Heard and McDonald Islands Honduras Croatia (Hrvatska) Haiti Hungary Indonesia Ireland Israel India British Indian Ocean Territory Iraq Iran Iceland Italy Jamaica Jordan Japan Kenya Kyrgyzstan Cambodia Kiribati Comoros Saint Kitts And Nevis Korea, North Korea Kuwait Cayman Islands Kazakhstan Laos Lebanon Saint Lucia Liechtenstein Sri Lanka Liberia Lesotho Lithuania Luxembourg Latvia Libya Morocco Monaco Moldova Madagascar Marshall Islands Macedonia, Former Yugoslav Republic of Mali Myanmar Mongolia Macau S.A.R. Northern Mariana Islands Martinique Mauritania Montserrat Malta Mauritius Maldives Malawi Mexico Malaysia Mozambique Namibia New Caledonia Niger Norfolk Island Nigeria Nicaragua Netherlands, The Norway Nepal Nauru Niue New Zealand Oman Panama Peru French Polynesia Papua new Guinea Philippines Pakistan Poland Saint Pierre and Miquelon Pitcairn Island Puerto Rico Portugal Palau Paraguay Qatar Reunion Romania Russia Rwanda Saudi Arabia Solomon Islands Seychelles Sudan Sweden Singapore Saint Helena Slovenia Svalbard And Jan Mayen Islands Slovakia Sierra Leone San Marino Senegal Somalia Suriname Sao Tome and Principe El Salvador Syria Swaziland Turks And Caicos Islands Chad French Southern Territories Togo Thailand Tajikistan Tokelau Turkmenistan Tunisia Tonga East Timor Turkey Trinidad And Tobago Tuvalu Taiwan Tanzania Ukraine Uganda United Kingdom United States Minor Outlying Islands United States Uruguay Uzbekistan Vatican City State (Holy See) Saint Vincent And The Grenadines Venezuela Virgin Islands (British) Virgin Islands (US) Vietnam Vanuatu Wallis And Futuna Islands Samoa Yemen Mayotte Yugoslavia South Africa Zambia Zimbabwe * Phone (include area code & extension) Fax (include area code) * Email Web Site What's the best way to reach you?     What's the best time to reach you?     What's your organization's main business?     What computer hardware/software products do you sell?   Does your organization specialize in particular markets?   In what geographical area would you like to sell our products?   Number of employees?   Annual sales?   Comments

© 2000-2003 Brigadoon Software, Inc. All rights reserved