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     Last Name

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     Phone  Use this format with no parenthesis or 1-
              555-555-5555 (10 digits separated with hyphens)
                 Area Code & Number

      Would you like someone to contact you by phone?         Yes  No   

          I am             a vending route operator
                      buying machines to use in our office

      How soon do you need them?

ASAP   2 Weeks   1 month
2 to 4 months   Just Looking

      I would like prices on the following machines:

           Mechanical Snack & Soda Machines or Combos
           Electrical Snack & Soda Machines or Combos
           Refurbished Electrical Snack & Soda Machines
           Coin Mechs & Validators (Mars, Conlux, etc...)
           Dollar Bill & Token Changers
           Cigarette Vending Machines
           Bulk Candy or Capsule Machines
           Medical Vendors (aspirin, tylenol, etc..)

To help us serve you better, please take the time
to answer the following 3 questions...

    When buying these machines, other than pricing,
    what is your 1 biggest question?
           

     Now, if you have any, what is your main (1) concern?
           

     So that we can make some suggestions,
       - What will the use be and what type of business is it?
       - How many employees / customers per day?