H. E. LONG Company
3910 ANDERSON ROAD
P.O. BOX 197
MORROW, OH 45152 E-MAIL [email protected]
PHONE 513-899-2610 WEB URL
http://www.helongco.comFAX 513-899-4094
Company Name:
__________________________________________________Shipping Address: __________________________________________________
City, State, Zip: __________________________________________________
Phone Number: __________________________________________________
Fax Number: __________________________________________________
Web Site/ E-mail: __________________________________________________
Billing Address: __________________________________________________
City, State, Zip: __________________________________________________
Phone Number: __________________________________________________
Fax Number: __________________________________________________
Contact / E-mail
President: __________________________________________________
Buyer: __________________________________________________
Sales Manager: __________________________________________________
Inside Sales: __________________________________________________
Outside Sale: __________________________________________________
Thank you for taking the time out of your busy schedule to fill out this form.
Please return it to the address or fax number above.