A Foreign Affair Brochure Request

First Name:
Last Name:
Email Address:
Mailing Address:
City:
State
Zip Code
Country
Phone
	Yes, please give me a call at this number to discuss my exciting singles tour! (We normally wait until after estimated delivery of your package. If you wish not to be contacted by phone please uncheck box)
Previous Tour Client?	yes no
Destination of Interest:
Enter Any Comments, Questions or Needs:
Choose appropriate postage and handling:
	$5.99 1st Class USPS Mail (U.S. & Canada Only - normal 2 to 5 day delivery)
	$15.95 1st Class USPS International Mail (OUTSIDE U.S. & Canada - normal 8 to 10 day delivery)
All requests are normally shipped next business day. For expedited or express delivery options please call our office at (602) 553-8178. Delivery times above are estimated and not guaranteed.

If you prefer to mail a check or money order please complete this form
and submit it. Then click on "Mail, Fax or Call In Credit Card".

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Contact Information

Address: 123 Street Name Adress, City Name, 12345
Phone: 123-456-7890
Fax: 123-456-7890
Email: Info@sampledomain.com

This program is the sole property of Company Name and may not be copied in any way or form without express permission from Company Name.