Information Request Form

Section:	Main.A2. TRADEMARK. INDEX. H-Hm.Halia.Halia AOP
Code:	88254
Product:	USA. A
Company or Organization:
Contact's name *:
Position:
E-mail:
Mailing address:
Phone number:
Fax number:
Fields of interest:	MARKETER'S COUNTRY COMPANY LICENSOR PATENT NUMBER PRODUCT
* If you are not linked to any company or organization complete at least this field