DIMACC, Inc. - Information Request Form

Information Request Form

DIMACC would be pleased to provide you with product samples and additional information, as available. You must fill out the following form completely so we can process your request. We will send you your request via regular mail.

Privacy and Confidentiality Statement
All information will be kept strictly confidential and will not be shared with any third parties. All information provided will be used solely for the purpose of processing your information request. DIMACC will not contact you unless specifically requested by you.

Please send me (check all that apply):

DIMACC Sampler CD-ROM - The Power of Multimedia

(for Windows 95, 98, NT and Macintosh PowerPC)

Micromax Recruiter CD-ROM

(for Windows 95, 98, NT)

Any available CD-ROM(s)

Please specify desired format:
Windows
Macintosh PowerPC
Either

Other information and/or samples (please specify):

	Dr. Ms. Mr.
Name:
Company:
Title:
Address 1:
Address 2:
City:		State/Prov.:
Postal Code:		Country:
Tel:		Fax:
Email:
Website URL:

Thank you. We will process your request as soon as possible.