Contact Form
 
(Company Inquiry/Registration)

Name:   Title:   If other:
Company Name:   Job Title:
Company ID:      
Street:   Town:
Country:   Postal Code
We do not share our email database with anyone!!!
As business-people, we respect how valuable your time is and we know you do not need extra mail. We will use this database to contact you, with updates on our products, so make sure to put an email address that you use.
Phone:   Fax:
e-mail:   Website:
         
We would like to register as an associate company, receive the D. & G. COMEX periodic newsletter and be sent a username and password to access the ASSOCIATE SECTION of the D. & G. COMEX website:
I would like to register                      No, please don't register
 
Type of business:




  Detailed description of your business
     
Interested In GO – Drinks in Tubes
Promotion Tubes – Tube drinks with your design
Hanfblüte Bier – Beer made with hemp blossoms
VK Vodka Pure
VK Vodka Kick – Vodka based drinks
VK Kick Beer – Beer based flavored drinks
VK Mojito – Rum based drinks
VK Corky's Shots– ?????
Other 		Details
     
Requesting Product Information
Prices
Offer (state details of product and quantities)
 Details
         
Please fill out the following questionaire (not obligatory)
How did you find out about us?
  I saw the product -      
in a shop   Place & Name
in a bar   Place & Name
in a Supermarket   Place & Name
at an event   What event ?
found it on the internet   What Site ?
media/newspaper/magazine   Which one ?
saw it on a trade show   Which one ?
other   Please Specify
         
     
         
NOTE: For sample tubes, please fill in the appropriate form.