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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)
--
_6_
and
small 'C' +3 letters
-
(((((??? - 3) * 2) - 7) - 8) - 9) = -22,
3 chars before small Z
followed by
small 'B' +3 letters
&