H. E. LONG Company

3910 ANDERSON ROAD

P.O. BOX 197

MORROW, OH 45152 E-MAIL rick@helongco.com

PHONE 513-899-2610 WEB URL http://www.helongco.com

FAX 513-899-4094

We are updating our files and would appreciate it if you could supply us with the following information:

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: __________________________________________________

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Please return it to the address or fax number above.