CHP-CORP / KAESER & BLAIR, INC.

Referral Form

Fill out the following form and after we review it we will send you your gift. Thank you!

(items with an asterisk are required)
Your company name:

* Your first name:	* Your last name:

* Your Phone:	* Your e-mail address:

* Your Street address:

* Your city:	* Your state:	* Your zip:

* May we use your name when contacting your referral?:
Yes No
* What does your referral purchase more of?:
Promotional Products Commercial Printing Wearables All of the above
* Referrals Name:

* Referrals Company:

Referrals Title:

* Referrals Phone:	* Referrals e-mail address:

What can you tell us about this person?:

* Which free gift have you selected?: