2901 Moorpark Avenue, ste. 100, San Jose, CA 95128
          Tel: (408) 248-8811  Fax: (408) 551-6882
 http://www.applied-computer.com	

CUSTOMER CONTACT INFORMATION

In order for us to serve you better, please enter the following information on this form and FAX to us at (408) 551-6882. If you have questions, call us at (800) 609-1702.

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Invoice/accounts payable contact (name, voice phone, FAX number)
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After hours contact (name, phone number) in case of problems on your order
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With this information, we will be better able to provide the level of customer service you expect.

Thank you very much for your assistance.
Applied Computer Online Services