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HOMETOWN USA

PC Build Request Form

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ACTION="/cgi-bin/script_library/form_handler_mail"
METHOD=POST>

Customer Profile

Name:

     Phone#:

Address:

 Business#:

City, State Zip:

Email:

Case:

 Floppy:

MoutherBoard:

 Modem:

Network Card:

 USB: 

Memory:

 CPU:

Fan:

 Hard Drive:

CD-Rom:

 CD-Writer:

Speakers:

 Monitor:

Mouse:

 Keyboard:

Special Instructions:


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