About You

Is this the first time you've visited our site? Yes No

WE ARE CURRENTLY REPRINTING OUR CATALOG. PLEASE FILL OUT THE INFO BELOW AND WE WILL SEND YOU A CATALOG VIA EMAIL, AND ANSWER ANY QUESTIONS YOU MAY HAVE.THANK YOU FOR YOUR INTEREST IN BRATWEAR.
 
Rank/Title:

First Name:

Last Name:

Agency:
Dept. Address:
City:
State: Zip Code:
Phone:
Fax:
Email:
Dept. Web Site:
 
If a request is made to send a catalog to a home address, indicate below.
YOU MUST INCLUDE THE DEPARTMENT INFORMATION FOR OUR RECORDS.
Home Address:
City:
State: Zip Code:
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Other Contact Number:
     

Do you currently have a bicycle patrol?Yes No
If yes, what uniform brand do you wear?
 

Is your department considering a new uniform?Yes No
If yes, what will influence your decision to purchase Bratwear?
 

How did you hear about us ?
 

Additional Comments:
 

Thank you!