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Name:		•
Address:
City:		•
Province:
E-mail address:		•
Telephone:
Fax:
Web site URL:
Communication preference (check all that apply):		Telephone;Fax;E-mail
How did you hear about us?:
Are you interested in our competitive upgrade offer?:		Yes No (See ad below)
Which plan interests you?:
Entries marked (•) are required for form to be successfully sent.