Information Request Form

    This form can be used for various purposes from requesting information you couldn't find in our Web Pages, supplying us with information on items you wish to order, or to request a service consultation.

    If you would like more information about our products, have special needs, or have questions about something not addressed in our web pages. Please fill out all pertinent information and send this form to us using the "Submit Button" at the bottom of this page.

    If you wish to set up a phone consultation with us, please take the time to fill out the information blanks pertaining to the items you are interested in. This will assist us in determining some or your needs prior to the phone consultation, which will make it more productive for both of us.

    Please be assured that information gathered on this form is only used for the above stated purpose. If you wish to be put on our e-mail or mailing list for special offers, please check the appropriate box on this form.

    We thank you for your interest in our products.
Leo Templeton, Owner: Valley Fire & Safety™
Your Name:
Organization Name:
Physical Address:
Mailing Address:  (If Different From Physical Address)
City:
State or Province:
Zip Code:   
E-mail Address:    Required For Our Server To Process This Form!

Phone Number:  Area Code, Number, Extension
Fax Number:  Area Code, Number, Extension
How did you find us?

If there was an asterisk (*) next to your selection. Please elaborate here. Thank You!
The best way to contact me is by:
The best time to telephone is:
First Preference Date For Consultation:
Second Preference Date For Consultation:
Please Check "All" Items
That Apply To This Inquiry!


We Wish
To Purchase Items
We Need A
Price Quote
We Wish
To Sell Items
We Need
More Information

Add Us To Your
E-Mail List
Add Us To Your
Standard Mail List
We Want A Sales Rep To Visit Us
We Want To Visit
Your Facility

Please
Telephone Us
We Have A Freight Damaged Shipment
We Have A
Lost Shipment
We Wish To
Thank You

Detailed Information

    Use this area to submit specific items you wish to order, sell, or need additional information on.

  • You can type information directly into the box.
  • If your information is elsewhere on your system you can "Cut & Paste" it into the box.
  • You can send it to us as an e-mail attachment to info@valleyfireandsafety.com after submitting this form.
    (Please Note: Attachments are best sent in "Plain Text" as we may not have the program you created the file in, on our system.)

Did you remember to include your e-mail address?
          
Our Server Will Not Send This Information To Us If You Did NOT!

 
Georgia "Main" Office

115 B Commercial Blvd.
Martinez, Georgia 30907

Phone: 1-603-387-8929


Web Site Information © Valley Fire & Safety Company 2002 - 2010
Web Site Layout & Design ©Web Venues Internet Services™ & Alan Miller 2002
Permanent Limited Use License Granted To: Valley Fire and Safety Company, By Web Venues Internet Services 2002
Second Generation Website Created: 10 June 2002. Last Update: 16 November 2010 @ 1920 Hours, Pacific Time.