Information Request - Harris Specialty Advertising Products LLC

Information Request

Name:

Company Name:

Street Address:

Mailing Address (If different than above):

City / State / Zip:

Email Address:

Phone Number:

Description of Business:

Type of Product(s):

10.

Quantity

11.

Do you want your product(s) to have a text / graphic imprint or remain blank?

	Imprint			Blank
	Uncertain

12.

If you selected imprint, please explain what the imprint will include (logo, text, etc.)

Type in the text that you see above: