| What is your firm's name? | |||
| What is your Title? | Name? | ||
| What is your firm's mailing address? | Address1: Address2: City: Zip: | State: | |
| What Operating System do you use? | Other: | ||
| Which Database program? | Other: | ||
| Do you have Web access from your desktop? | Yes No | ||
| Do you have an E-Mail Address? | Yes No | E-mail adress: | |
| Would you use 24hour updates from a secure Web sight? | Yes No | Comments: | |
| Are you willing to use Mo-Kan's secure web server to place a Repo order? for a price reduction? | $5 $10 | Other: | |
| Would you participate in a Real time, On-Line auto/ truck liquidation auction? | Yes No | Comments: | |
| Are you interested in Single Point Order Entry, i.e.: co-ordination with other Agencies assigned by Zip? | Yes No | Comments: | |
| Would you like a representative to call? | Yes No | Phone #: | |
| Would you like us to mail you a certificate for the car drawing? | Yes No |
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