Country or Territory:
    United States of AmericaCanadaAfghanistanAlbaniaAlgeriaArgentinaAustraliaAustriaBelgiumBrazilBulgariaChileChinaColombiaCosta RicaCroatiaCzech RepublicDenmarkEcuadorEgyptEl SalvadorFinlandFranceGermanyGreeceHong KongHungaryIndiaIndonesiaIrelandIsraelItalyJapanJordanKorea, SouthLebanonMalaysiaMexicoMoroccoNetherlandsNew ZealandNorwayPakistanPeruPhilippinesPolandPortugalPuerto RicoRomaniaRussiaSaudi ArabiaSingaporeSouth AfricaSpainSwedenSwitzerlandTaiwanThailandTurkeyU.S. Minor Outlying IslandsUkraineUnited Arab EmiratesUnited KingdomVenezuelaYugoslavia (Former)

Business/Home Phone 
               Fax Number     
               Pager/Mobile  
             E-MailAddress 
How did you hear about us? Another WebsiteMagazine Article or AdYellow pagesTelevision advertisementPrint advertisementRadio advertisementA friendOther 

Indicate Payment Method:

  Money Order    Check

Note: Checks must be made payable in U.S. funds.

Drawn on U.S. Bank. Using U.S. tracking numbers.

Items Requested 1:

Items Requested 2:

Items Requested 3:

Items Requested 4:

Which Automobile Magazines do you read on a regular basis?

	Hemmings Motor News		Street Scene
	Old Cars
	Car Trader
	Rod & Custom
	Hot Rod
	Southern Rodder		None

What are the top three(3) reasons influencing the purchase of your VARCO Inc. product.

	Received as a Gift		Prior Experience
	Value for Price		Color / Appearance
	Quality / Durability		Component Selection
	Workmanship		Weight of Item
	VARCO Inc Reputation		Advertisement
	Frame Design / Materials		Recommendation of Friend / Family
	Recommendation of Salesperson		Other