Information Request Form

Section:	Main.A1. CORP. INDEX. G-Gm.GlaxoSmithKline/P C2.2001. 02.19.2001. (Animal Test.).Co. is customer of:
Code:	31653
Product:	UK. G
Company or Organization:
Contact's name *:
Position:
E-mail:
Mailing address:
Phone number:
Fax number:
Fields of interest:	COMPANY
* If you are not linked to any company or organization complete at least this field