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Your Business Name
2111 Your Street City, State and Zip Code
Phone: xxx-xxx-xxxx Fax: xxx-xxx-xxxx

Business Hours: M-F 8:00 am - 5:00 pm CST

Sample Customer Form:

We want to be responsive to your questions or issues. Please help us by choosing the type of question you are submitting, then fill out the necessary information.


Customer Service Question
  Technical Support Question
  Billing or Purchase Question

First Name:

Last Name:

Email Address:


Fax Number:

Order or Receipt Number:

Please Enter Your Question or Comments Below:

Important Note:

Please note that this form IS active.  We have, created a "Thank You" page which is included with the template. To test this feature, simply fill out the form and click the submit button. When you or your visitors complete the form, they will be directed to your customized thank you page.

Remember that you will have to reset the form properties before you publish your web.