American Administration Services Co.

Information Request Form

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Request for Information  Suggestion   Other:

Please provide the following information:

                                   Your Name or the Contact Name:
                                                                   Telephone #:
              Name of your Company, Union or Organization:
Estimated number of Employees or participants involved:

Please tell us what you think about our solutions, or anything else that comes to mind by typing your comments, requests or suggestions in the following box:

         Please contact me as soon as possible regarding this matter.


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Copyright 2001 [American Administration Services Co.]  All rights reserved.  Revised: 02/26/05.