Please use this form to request a catalog, a quotation for sale
or rental, or to purchase equipment.  Kindly print and fill out
this form, then fax back to Imagic Design (Fax no: 604-451-4063).

Contact Name: __________________________________________________
Company Name: __________________________________________________
Street Address: ________________________________________________
City: ____________________________  State/Province: ____________
Zip/Postal Code: _________________  Country: ___________________
Telephone: _______________________  Fax: _______________________
E-mail: ________________________________________________________  

I am interested in: (brief description) 
 _______________________________________________________________
 _______________________________________________________________
 _______________________________________________________________
 _______________________________________________________________
 _______________________________________________________________

I want to sell to Imagic Design: (please include mfr/model,  
condition, accessories, comments, age) _________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

Please keep me on your mailing list for: _______________________
________________________________________________________________