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REQUEST FOR INFORMATION FORM

You can communicate with me as follows:

1 Westmount Square
Suite 1500
Montreal, Qc, H3Z 2P9
Telephone : (514) 935-6226
Fax: (514) 935-2314
e-mail :
ccouturier@pubnix.net

If you would like information on a particular topic please complete the following:

Your e-mail address:

Your name:

Name of your business:

Telephone number:

Fax number:

Briefly describe the information requested:

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