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Price & Delivery Information Request Form Please fill in all fields below to receive price and delivery information about specific Maury products. If a field does not apply enter "none". Contact Information: Name: Mail Stop: Company: Address: City: State: Zip Code: Country: Phone: Fax: Email: Please send me information about the following item(s). Enter Model number (if known), item description and quantity desired (e.g., 3.5 mm male to N female, Model 8023, Qty 3). How do you wish to receive the information? By Phone By Fax By Email By Mail Optional Survey Thanks for requesting information or literature from Maury Microwave. While you're here, please take a moment to fill out the following short survey. The results will help us serve you and others better. Skipping the survey portion of this form will not effect your request. How did you learn about Maury Microwave products? (Please check all applicable boxes.) Web Search Tradeshow Exhibit Referral Trade Publication Sales Rep If "Trade Publication" is checked, please specify: Magazine Ad New Product Update Feature Article Name of Publication: Microwave Journal RF Design Microwave & RF Microwave Product Digest Microwave & RF Product Directory Test And Measurement World Wireless Design and Development Applied Microwave & Wireless Month of Publication: January July February August March September April October May November June December If you heard of us in some other way, please specify: Thank you for completing this survey.

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