Sample Form - Data Returned as FDF

Sample use only. The information provided is returned to the sender in FDF format. Null entries are dropped.

First Name:
Middle Name:
Last Name:
Street, R.D. or P.O. Box:
City:
State:
9-digit Zip Code:
Telephone:
E-mail Address:

Questions? Comments? Please contact the Author at . Thank you for your support.

Revision History: / 13Mar2001 - Original issue / 10Apr2001 - Counter added / 21Aug2002 - E-mail links removed /

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Copyright 2001 - William Alexander Segraves - All Rights Reserved