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Urgent Response Form

When you complete and send this form, it will automatically be marked “Urgent Response” when we receive it.  This is to be used ONLY by persons needing immediate assistance who may have found themselves in possibly the uncomfortable position of needing products in hand ASAP-PRONTO-YESTERDAY-RIGHT AWAY!!!!  The form is brief and to the point so be certain to fill out all the information required accurately but most importantly the phone number portion.  All inquiries through this venue will be handled by way of a DIRECT telephone call.  If you want the indirect and impersonal approach of e-mail do not use this form.  If we an unable to speak to you directly or leave you a voice mail message on the number(s) you provided via this form, the only e-mail you will receive from this form is that we called you. 

EXAMPLE: Blank, from CCAO called you today (date), at (time), and left a phone message or no one answered at that time. It now is up to you to telephone us back at 877-265-2247 !  Thank you for your interest...

Please list phone numbers in the order of priority.  Starting with phone number 1 being the best and most likely to reach you!

Please make an assertive effort to provide us with the most concise information that will provide us with the most useful data as to when, where and how to contact you by telephone.  Please give a number that has some type of answering machine/voice mail on that phone line if it is available to you.


Email Address:
Company Name:
First Name:
Last Name:
Phone 1: Area Code-
Phone 2: Area Code-
Phone 3: Area Code-

Comment Box: 

 -After you press [send] please wait for the next screen.-

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