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PHONE: 800-323-6259
FAX: 847-669-3230
maassmidwest.com
sales@maassmidwest.com
American made quality and reliability for over 60 years.
Your ONE source for water well products.

Catalog or Information Request Form

Print this form, complete it, and fax it to 847- 669 - 3230
- OR -
mail to Maass Midwest, P.O. Box 547, Huntley, IL 60142-0547


YOUR NAME: _______________________________________________________________________

TITLE (optional): _______________________________________________________________
Please check one:  check box Engineer   check box Driller   check box Wholesaler   check box Other___________________

COMPANY ________________________________________________________________________

Street _______________________________________________________________________

P.O. Box _____________________________________________________________________

CITY______________________________   STATE____________   ZIP___________________


PHONE NUMBER starting with area code: _________________________________   ext:____________

FAX NUMBER starting with area code: ____________________________________

E-MAIL: ____________________________________

check box Send your product catalog to my attention at the above address.

check box I'd like more information on the following products:

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________