Ray Jan Internet Solutions:

Items with a * beside it are required.

*First Name

Last Name

Please provide the following contact information:

Title

*E-mail

*Organization

* Street Address

Address (cont.)

*City

*State/Province

*Zip/Postal Code

*Country

*Contact Phone #

Home Phone #

FAX

URL

Please provide the following ordering information:

QTY
*DESCRIPTION- Product/Service Requested

Please include any other information you feel that could help
us give you an accurate quote.

Please provide as many details as possible
:

Organization Address

(if not same as above)

Street Address

Address (cont.)

City

State/Province

Zip/Postal Code

Country

Please Enter the Date of Your Request :

-- mm/dd/yy

Rayjan's Internet Solutions reserves the right to refuse any discount to any
organization without any explanation required!

Although this is true, Please do not let that keep you from contacting us!
It is very likely that you may qualify for extreme discounts!