Your feedback is important to us.
Use either form below to contact us.

1. Fill in the required fields and comments or questions then send them to us by clicking the submit button.
2. Make sure you reference URL page(s) if you are notifying us of broken links.

Information Request Form:

1. Check as many products as you are interested in.
2. Fill in the address fields required for us to contact you.
   

Thank you for taking the time to contact us!

Comments:
Your full name*:
Your e-mail address*:
*Required Fields.
I have a question or commment:
Here' where to list URL(s) of broken page or graphic link(s) within the Valantex website:

Information Request:
I am interested in:
		VAL/CCQ		VAL/EIS
		VAL/PAY		VAL/Sell
		Brochure		Demo CD
		Other:		Type all other requests here.

	I am already on the VALANTEX mailing list and my e-mail is:
	Jump down to SUBMIT button.
	I am not on your mailing list. Please send information to me.

Please fill in all fields below if you are not on our mailing list.
Mr. Ms. Mrs.		*Required fields.
First Name*:
Last Name*:
Job Title*:
Company Name*:
Street Address 1*:
Street Address 2:
City*:
State*:			Zip Code*:
Phone Number*:			Fax Number:
E-mail*:
		I prefer to be contacted by e-mail.
		Snail mail preferred .
Thank you for joining the VALANTEX.com mailing list.