Resource Guide Data Entry Form

(This is not the correct form to be used for Personal Ads!)


Information that you think should be added to our Resource Guide.


        Company Name 
Contact Name
Their e-mail address
Address Line1
Address Line 2
City
State/Province
Country
ZIP/Mail Code
Telephone #1
Telephone #2
Facsimile Phone #
BBS Phone #
Comments/Remarks/Services offered/etc.: Where did you hear about our Resource Guide:
Information about you: (Used strictly for profiling! None of this information will be published) Your Email Address:
Company Name:
Contact Name:
Address Line1:
Address Line 2:
City:
State/Province:
Country:
ZIP/Mail Code:
Telephone #1:
Telephone #2:
Facsimile Phone #:
BBS Phone #:
Your age:
Male Female TV/TG/TS I prefer not to disclose Comments/remarks about you/etc. Send this form /or/ Cancel this information

Prepared by Robin Roberts -- © 1995,99
Email address: Send E-Mail directly to robin@backdrop.net