<p> JOHN F. KILROY CO., INC. Customs Brokers & Int’l Freight Forwarders One Cross Island Plaza, Suite 203E ~ Rosedale, NY 11422 ~ U.S.A. Tel: 718-656-7818 ~ FMC 000114NF ~ Fax: 718-656-8888 Email: [email protected] Web Site: www.jfkilroy.com</p><p>Please print or type form and return to us.</p><p>Company Name: ______</p><p>Address: ______</p><p>City: ______State: ______Zip: ______</p><p>Tel: ______Fax: ______</p><p>Email address: ______</p><p>If you wish to have our invoices be directed to the attention of a specific person or department, please complete:</p><p>Att: ______</p><p>Please list the name of the person to contact regarding: 1. Shipping Details 2. Product Information 3. Other general information</p><p>Name: ______Dept: ______Tel: ______</p><p>Name: ______Dept: ______Tel: ______</p><p>Name: ______Dept: ______Tel: ______</p><p>Please indicate if you have any special instructions or operation procedures you require us to follow:</p><p>Dependable Service Since 1932</p>