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B&T Industries

Product Request Form

HomeProduct Request Form

Name(Required)

First Last

Email(Required)

Daytime Phone(Required)

Company Name

Shipping Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Product name, model and quantity requested:(Required)

How did you first learn about our products?(Required)

What will our product(s) be used for?(Required)

In what media formats will our product(s) be shown?

How can we access completed work of our product(s)?

Will this be used for social media?

Please, reference any previous projects for review including social media accounts, published works, websites, etc:

Other comments

Submitting this completed form will give us the basis for making a decision. On occasion, additional information for clarity will be required and sought. The more information we have on you, your organization and intended efforts, the better.

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