Brochure and Price List Request Form

Please provide the following contact information:  
Title*  
First Name*  
Last Name*  
Position      
Organisation  
Street Address*  
Address (contd.)  
City*  
County  
Postcode*  
Work Phone  
Mobile Phone  
Fax  
Email*  
         
Which product(s) would you like to receive information on? *
To select more than one product,
hold down the ctrl key whilst
clicking on each product.		      
       
         
How did you hear
first about us? *		  
Other  
         
Please enter any particular comments or questions relating to your enquiry (e.g.: what application you have in mind):  
In an effort to reduce paper wastage and in keeping with our environmental policy, we will be pleased to email you a copy of our literature, as a pdf file. This is quicker and easy to view, print and save for future reference. If you would prefer to receive them by post, please change the selection:  
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The data collected within this form will only be used by Golden Plan Ltd, GP Care Systems. The data will not be disclosed to any other organisation and is subject to regulation by the Data Protection Act 1998.

We may occasionally wish to send you information on our product updates. If you do not wish to receive this information, please check this box:

    
         
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