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* required fields
name: * postal code:
address: phone:
city: fax:
province: email: *

questions and comments: *
Enter the security code below: *

Guess the letters and numbers
(passphrase riddle)
--
small 'P' +3 letters
and
(((??? - 6) * 4) - 5) = -5
;
2 chars before small E
-
/9/
and then
small 'B' +1 letters
followed by