Terms, Conditions and Policies

TERMS AND CONDITIONS

Please read these Terms and Conditions (“Terms”, “Terms and Conditions”) carefully before using the https://www.tailgatefix.com website (the “Service”) operated by Banks Morrison Innovations, LLC (“us”, “we”, or “our”).

Your access to and use of the Service is conditioned on your acceptance of and compliance with these Terms.  These Terms apply to all visitors, users and others who access or use this Service.

By accessing or using the Service you agree to be bound by these Terms. If you disagree with any part of the terms then you may not access the Service.

 

Termination

We may terminate or suspend access to our Service immediately, without prior notice or liability for any reason whatsoever, including, without limitation, if you breach the Terms.

All provisions of the Terms which by their nature should survive termination shall survive termination, including, without limitation, ownership provisions, warranty disclaimers, indemnity and limitations of liability.

CAUTION WARNINGS:

Banks Morrison Innovations, LLC works hard to produce and manufacture the best products possible and has gone to great lengths to thoroughly test each of our products for Safety and Reliability. However, Banks Morrison Innovations, LLC cannot be held responsible for damage or injury to any customer and/or customer’s property due to damage incurred while installing or operating any product(s) purchased by customer from Banks Morrison Innovations, LLC.  Customer must accurately follow the installation and operational instructions provided by Banks Morrison Innovations, LLC exactly as provided to Customer upon the purchase of any such product(s).

Customer, upon purchase and acceptance of any product(s) from Banks Morrison Innovations, LLC does hereby agree to hold Banks Morrison Innovations, LLC harmless from any liability and/or responsibility for any damages or injury that may occur to customer, customer’s property and/or any others that may be effected by or injured or damaged by customer as a result of the customer’s purchase and installation of any product(s) manufactured by Banks Morrison Innovations, LLC.

 

PRIVACY NOTICE

This privacy notice discloses the privacy practices for Banks Morrison Innovations, LLC. Our privacy notice applies solely to information collected by this website. It will notify you of the following:

  1. What personally identifiable information is collected from you through the website, how it is used and with whom it may be shared.
  2. What choices are available to you regarding the use of your data
  3. The security procedures in place to protect the misuse of your information.
  4. How you can correct any inaccuracies in the information.

Information Collection, Use, and Sharing
We are the sole owners of the information collected on this site. We only have access to/collect information that you voluntarily give us via email or other direct contact from you. We will not sell or rent this information to anyone.

We will use your information to respond to you, regarding the reason you contacted us. We will not share your information with any third party outside of our organization, other than as necessary to fulfill your request, e.g. to ship an order.

Unless you ask us not to, we may contact you via email in the future to tell you about specials, new products or services, or changes to this privacy policy.

Your Access to and Control Over Information
You may opt out of any future contacts from us at any time. You can do the following at any time by contacting us via the email address or phone number given on our website:

  • See what data we have about you, if any.
  • Change/correct any data we have about you.
  • Have us delete any data we have about you.
  • Express any concern you have about our use of your data.

Security
We take precautions to protect your information. When you submit sensitive information via the website, your information is protected both online and offline.

Wherever we collect sensitive information (such as credit card data), that information is encrypted and transmitted to us in a secure way. You can verify this by looking for a lock icon in the address bar and looking for “https” at the beginning of the address of the Web page.

While we use encryption to protect sensitive information transmitted online, we also protect your information offline. Only employees who need the information to perform a specific job (for example, billing or customer service) are granted access to personally identifiable information. The computers/servers in which we store personally identifiable information are kept in a secure environment.

If you feel that we are not abiding by this privacy policy, you should contact us immediately via [email protected]

Registration
In order to use this website, a user must first complete the registration form. During registration a user is required to give certain information (such as name and email address). This information is used to contact you about the products/services on our site in which you have expressed interest. At your option, you may also provide demographic information (such as gender or age) about yourself, but it is not required.

Orders
We request information from you on our order form. To buy from us, you must provide contact information (like name and shipping address) and financial information (like credit card number, expiration date). This information is used for billing purposes and to fill your orders. If we have trouble processing an order, we’ll use this information to contact you.

Cookies
We use “cookies” on this site. A cookie is a piece of data stored on a site visitor’s hard drive to help us improve your access to our site and identify repeat visitors to our site. For instance, when we use a cookie to identify you, you would not have to log in a password more than once, thereby saving time while on our site. Cookies can also enable us to track and target the interests of our users to enhance the experience on our site. Usage of a cookie is in no way linked to any personally identifiable information on our site.

Some of our business partners may use cookies on our site (for example, advertisers). However, we have no access to or control over these cookies.

 

Sharing
We share aggregated demographic information with our partners and advertisers. This is not linked to any personal information that can identify any individual person.

And/or:
We use an outside shipping company to ship orders, and a credit card processing company to bill users for goods and services. These companies do not retain, share, store or use personally identifiable information for any secondary purposes beyond filling your order.

And/or:
We partner with another party to provide specific services. When the user signs up for these services, we will share names, or other contact information that is necessary for the third party to provide these services. These parties are not allowed to use personally identifiable information except for the purpose of providing these services.

Links
This website contains links to other sites. Please be aware that we are not responsible for the content or privacy practices of such other sites. We encourage our users to be aware when they leave our site and to read the privacy statements of any other site that collects personally identifiable information.

Surveys & Contests
From time-to-time our site requests information via surveys or contests. Participation in these surveys or contests is completely voluntary and you may choose whether or not to participate and therefore disclose this information. Information requested may include contact information (such as name and shipping address), and demographic information (such as zip code, age level). Contact information will be used to notify the winners and award prizes. Survey information will be used for purposes of monitoring or improving the use and satisfaction of this site.

 

 

RETURNS AND REFUNDS POLICY 

The Tailgate Fix Guarantee

We provide a 100% Satisfaction Guarantee on all products we sell against defects or damage.

Please inspect your items fully upon receipt. Please contact us immediately if you have any questions or concerns with your order. We always work with our customers quickly to resolve any issues that may arise.

 

Refunds

Refunds can be granted in full or in part. The percentage of refunds given is at the sole discretion of the company and is dependent on the condition of the item when received back from the customer.

The customer must follow the procedure outlined below in the RETURNS section in order to request a refund. The customer must first request a Return Authorization Number then return the item back to the company according to the guidelines below. Refunds, once approved, will be processed within 24-48 business hours of receipt of merchandise.

 

Returns

A return is an item a customer sends back to the company. We evaluate the condition of each returned item and the reason it is being returned. If you need to return an item, you must notify us by emailing your request here: [email protected].

When returning your item, please package it in an appropriate box to withstand the rigors of shipping. Ensure all components are included. Shipping costs for returns are at the expense of the buyer. A $25.00 restocking fee will be applied for any returns that are not due to manufacturer’s defect.

 

The following conditions must be met in order to complete your return:

  1. This is a high-value item and must be sent with insurance to cover the original purchase price
  2. The return package must be sent First Class Mail with a tracking number through the Post Office.
  3. The tracking number has to be communicated with the seller immediately upon shipping – this information must be emailed to [email protected].
  4. Returns must be sent within 7 business days after requesting to be returned.
  5. Package must be packed with filler materials to avoid any movement while in transit to protect from damage.

 

Returns Timeframe

In most cases, customers can request to return an item within 30 days of receiving it. If there is an extenuating circumstance, we may make a case-by-case exception and accept the return request beyond 30 days of receipt. Once requesting a return, the package must be shipped within 7 business days and communicate the tracking number to the company.

We do not accept responsibility nor reimburse for returned items that are damaged by a customer.

 

Restocking fee

All items are subject to a $25.00 restocking fee if the return is being requested through no fault of the company. All items are shipped with “FREE SHIPPING” so the restocking fee is to recover our shipping costs and labor in processing the original and return orders.

 

Replacements

Replacements may be offered in the rare event of a manufacturer defect. This option would be in agreement with the customer to ensure their satisfaction to resolve the issue. Any replacement would be at the expense of the company and the customer would not incur any additional shipping or handling fees.

 

 

MANUFACTURER WARRANTY

This warranty applies to Banks Morrison Innovations (the “Seller”) parts only. The manufacturer warrants this product to be free from defects in workmanship and materials, under normal use and conditions, for a period of 90 days from the original invoice date. Shipping and handling fees are to be paid for by the customer. The manufacturer agrees, at its option during the warranty period, to repair any defect in material or workmanship or to furnish a repaired or refurbished product of equal value in exchange without charge (except for a fee for shipping, handling, packing, return postage, and insurance which will be incurred by the customer). Such repair or replacement is subject to verification of the defect or malfunction and proof of purchase as confirmed through the Seller’s warranty registration system.

This warranty applies only to the original purchaser of the part and only if it is still installed on the vehicle for which it was originally purchased. The warranty period on any part starts at the time of sale, not upon installation. This warranty is non-transferable.  If any defect is discovered during the warranty period, purchaser must notify seller immediately. All claims will be investigated and verified through the company warranty registration system.

Defects must be verified and all repairs must be authorized by the Seller. All transportation costs are excluded for this warranty. The Seller reserves the right to repair, replace or refund the purchase price of any part at its option. Any repairs or work must be pre-authorized before work is started. Warranty will be voided if any repairs or work (including but not limited to removing the part) is performed without prior written authorization from the Seller. Authorized repairs, replacements or refunds will satisfy all obligations of the Seller under this warranty. Any improper use or abuse, including but not limited to physical contact with foreign object, careless handling or damage resulting from improper installation, modification or repair will void this warranty. This warranty is in lieu of all other warranties, expressed or implied, including the warranties of merchantability or fitness for a particular purpose, application or use. The liability and obligation of the Seller under this warranty shall not exceed the price of the part as shown on the original invoice and shall not include any inconvenience, transportation, downtime, loss of vehicle, direct or indirect consequential damage. No labor expenses are covered under this warranty. No action by the Seller under this warranty shall extend the original warranty period or alter its obligations. This warranty gives you specific legal rights, and any cause of action must be filed within. The Seller has the right to request a secondary evaluation by a certified investigator of the part prior to fulfillment of warranty claim.

CLAIM PROCEDURES: Claims for defective merchandise must be made within 90 days from invoice date. Claims for items damaged upon receipt must be made within 10 calendar days after the merchandise is received.  Any claim for defective merchandise returns must be packed in original packaging. We reserve the right to specify that items be returned to the original warehouse for inspection. Pictures are required to claim defective merchandise, along with a copy of the original invoice.  If the claim is justified, the item(s) or part(s) will be repaired or replaced or a credit will be issued. It is our policy to replace parts whenever possible. This warranty gives you specific legal rights. You may have other rights, which vary from state to state.  All claim requests should be sent here for processing: [email protected]

 

IF YOU ARE A DEALER, CONTINUE BELOW…

 

DEALER PARTNER PROGRAM

Minimum Advertised Price (“MAP”) 

and 

Confidentiality Agreement 

This “MAP” and Confidentiality Agreement (“Agreement”) is made on this date of ___________________, by  and between, BANKS MORRISON INNOVATIONS, LLC, (“TAILGATEFIX”), and  

_______________________________________________, (“RESELLER”). 

IN CONSIDERATION OF and as a condition of TAILGATEFIX providing to the RESELLER the following defined rights  to purchase from TAILGATEFIX and resell our Product which contains Confidential Information in addition to other  valuable consideration, the receipt and sufficiency of which consideration is hereby acknowledged, the parties to  this Agreement agree as follows:

Minimum Advertised Price (“MAP”) 

Policy Terms and Guidelines 

TAILGATEFIX is focused on maintaining high margins for our RESELLERS, DEALERS, DISTRIBUTORS, “Authorized  Reseller” network. In recognition of the investment in time and resources required for our high-quality Reseller  network to provide the level of customer service and product knowledge expected from our customers,  TAILGATEFIX is committed to enforcing policies which allow our resellers to maintain high profit margins through  the sale of our products. TAILGATEFIX has an established Minimum Advertised Price (“MAP”) Policy that an  Authorized Reseller must follow for the advertising and marketing of TAILGATEFIX products. All TAILGATEFIX Authorized Resellers must agree to the terms and conditions of the following MAP Policy.

MAP pricing for all TAILGATEFIX products can be found on your current price list, which such MAP pricing will be  based upon the advertised price of TAILGATEFIX’s product(s) as shown on TAILGATEFIX’s website  (www.tailgatefix.com). All advertised prices must be at or above MAP for all TAILGATEFIX products. Resellers are  not required to list prices in advertising. If a price is listed in an advertisement, it must be at or above MAP. Other  statements such as “call for price” or “call for quote” are acceptable and permitted.

Resellers are also responsible for ensuring their TAILGATEFIX pricing is at or above MAP on internet search engines.  Resellers are free to set the actual resale price of any product as long as it is at or above MAP price given the most  recent publication of the price list as shown on www.tailgatefix.com. TAILGATEFIX’s MAP policy for all TAILGATEFIX

products apply to advertising placements, including but not limited to: print ads (inserts, magazines, newspapers,  catalogs, mail order catalogs, etc.), broadcast (radio and TV), direct mail, faxes, internet placement with third  parties (banner ads, broadcast emails, destination pages, third-party sites), internet placements on resellers own  website, and any flyers, posters or coupons.

From time to time, TAILGATEFIX may permit resellers to advertise MAP Products at prices lower than the MAP  price. In such events, TAILGATEFIX reserves the right to modify or suspend the MAP price with respect to the  affected products for a specified period of time by providing advance notice to all resellers of such changes.

Free Offers Associated with TAILGATEFIX Products 

Free shipping and/or handling, 0% sales tax, or free financing promotions do not violate the MAP.

All TAILGATEFIX Products Price Matching Policies 

Price matching policies are acceptable. Price matching cannot be used as a valid reason for violations of  TAILGATEFIX’s MAP Policy. Advertised and Sales price of TAILGATEFIX products must always be at MAP or higher.

Failure to Comply with the MAP Policy 

At the sole discretion of TAILGATEFIX, failure to comply with MAP, intentional and/or repeated failure to abide,  may result in the immediate loss of Authorized Reseller status and your ability to purchase all TAILGATEFIX  products both direct as well as through distribution.

TAILGATEFIX will utilize the following steps to resolve MAP violations: 

  1. Any and all resellers or dealers selling TAILGATEFIX products who have not signed a TAILGATEFIX MAP Policy agreement are classified as Unauthorized Resellers.
  2. Distributors of TAILGATEFIX are required to provide a signed MAP agreement from any reseller or dealer selling TAILGATEFIX products. Unauthorized dealers should not be sold to or provided a feed from any distributor whatsoever.
  3. Violations from Authorized Resellers will need to be corrected within 24 hours of notification. 1. First Violation: Authorized Reseller’s account will be put on hold temporarily and a written warning will be provided. MAP violations must be corrected within 24 hours. Upon correction and following 30 days of compliance, violation will then be cleared.
  4. Second Violation: Authorized Reseller’s account will be put on hold for 30 days.
  5. Third Violation: Authorized Reseller’s account will be put on hold for 180 days. After this duration, TAILGATEFIX will review and determine if account is to be reinstated.
  6. Fourth Violation: Should TAILGATEFIX decide to reinstate an Authorized Reseller who has previously demonstrated a third violation, yet violates a fourth time, the account will be unauthorized indefinitely.

***TAILGATEFIX may modify, from time to time, the pricing of TAILGATEFIX products and will issue a new price list  upon the first day of each quarter, based on a calendar year. MAP Pricing for all resellers or dealers must be  updated immediately upon receipt***

TAILGATEFIX Products Reseller Volume Purchase Discount 

Reseller Purchases : 10 to 24 Units in one order = 15% Price Discount 

Reseller Purchases : 25 to 49 Units in one order = 20% Price Discount 

Reseller Purchases : 50 or more Units in one order = 25% Price Discount 

BACKGROUND: 

  1. TAILGATEFIX has developed and invented various products containing proprietary information and  know-how that Reseller will be exposed to by TAILGATEFIX through this Agreement and per the terms of  this Agreement will be allowed to purchase/resell for TAILGATEFIX those certain product(s), (“Products”). TAILGATEFIX has already filed Patent Filing(s) on such proprietary Products within the United States  Patent and Trademark Office and/or has/will be filing in other Countries as well defining the details of  such proprietary Products.
  2. In connection with the RESELLER evaluating and purchasing these Products from TAILGATEFIX for Resale, (the “Permitted Purpose”), the RESELLER as such is requesting from TAILGATEFIX certain confidential  information (the “Confidential Information”) regarding these proprietary Products of TAILGATEFIX.

Confidential Information 

  1. All written and oral information and materials disclosed or provided by TAILGATEFIX to the RESELLER under this Agreement constitute Confidential Information regardless of whether such information was  provided before or after the date of this Agreement or how it was provided to the RESELLER.
  2. ‘Confidential Information’ means all data and information relating to the Products as well as data and  information relating to TAILGATEFIX, including but not limited to, the following:
  3. ‘Customer Information’ which includes names of customers of TAILGATEFIX, their  representatives, all customer contact information, customer services, data provided by  customers and the type, quantity and specifications of products and services purchased, leased,  licensed or received by customers of TAILGATEFIX;
  4. ‘Intellectual Property’ which includes information relating to TAILGATEFIX’s proprietary rights  prior to any public disclosure of such information, including but not limited to the nature of the  proprietary rights, production data, technical and engineering data, technical concepts, test  data and test results, simulation results, the status and details of research and development of  products and services, and information regarding acquiring, protecting, enforcing and licensing  proprietary rights (including patents, copyrights and trade secrets);
  5. ‘Marketing and Development Information’ which includes marketing and development plans of  TAILGATEFIX, price and cost data, price and fee amounts, pricing and billing policies, quoting  procedures, marketing techniques and methods of obtaining business, forecasts and forecast  assumptions and volumes, and future plans and potential strategies of TAILGATEFIX which have  been or are being discussed;
  6. ‘Product Information’ which includes all specifications for products of TAILGATEFIX as well as  work product resulting from or related to work or projects of TAILGATEFIX, of any type or form  in any stage of actual or anticipated research and development;
  7. ‘Production Processes’ which includes processes used in the creation, production and  manufacturing of the work product of TAILGATEFIX, including but not limited to, formulas,

patterns, molds, models, methods, techniques, specifications, processes, procedures,  equipment, devices, programs, and designs;

  1. ‘Service Information’ which includes all data and information relating to the services provided  by TAILGATEFIX, including but not limited to, plans, schedules, manpower, inspection, and  training information; and
  2. Confidential Information will also include any information that has been disclosed by a third  party to TAILGATEFIX and is protected by a non-disclosure agreement entered into between the  third party and TAILGATEFIX.

Confidential Obligations 

  1. Except as otherwise provided in this Agreement, the RESELLER must keep the Confidential Information  confidential.
  2. Except as otherwise provided in this Agreement, the Confidential Information will remain the exclusive  property of TAILGATEFIX and will only be used by the RESELLER for the Permitted Purpose. The RESELLER will not use the Confidential Information to produce like Products in a manner to compete against  TAILGATEFIX or for any purpose that might be directly or indirectly detrimental to TAILGATEFIX or any  associated affiliates or subsidiaries.
  3. The obligations to ensure and protect the confidentiality of the Confidential Information imposed on the  RESELLER in this Agreement and any obligations to provide notice under this Agreement will survive the  expiration or termination, as the case may be, of this Agreement and those obligations will last  indefinitely.
  4. The RESELLER may disclose any of the Confidential Information:
  5. to such employees, agents, representatives and advisors of the RESELLER that have a need to  know for the Permitted Purpose provided that:
  6. the RESELLER has informed such personnel of the confidential nature of the

Confidential Information;

  1. such personnel agree to be legally bound to the same burdens of confidentiality and  non-use as the RESELLER;

iii. the RESELLER agrees to take all necessary steps to ensure that the terms of this  Agreement are not violated by such personnel; and

  1. the RESELLER agrees to be responsible for and indemnify TAILGATEFIX for any breach  of this Agreement by their personnel.
  2. to a third party where TAILGATEFIX has consented in writing to such disclosure; and
  3. to the extent required by law or by the request or requirement of any judicial, legislative,  administrative or other governmental body.

Ownership and Title 

  1. Nothing contained in this Agreement will grant to or create with the RESELLER, either expressed or  implied, any right, title, interest or license in or to the intellectual property of TAILGATEFIX.

Remedies 

  1. The RESELLER agrees and acknowledges that the Confidential Information is of a proprietary and  confidential nature and that any failure to maintain the confidentiality of the Confidential Information in  breach of this Agreement cannot be reasonably or adequately compensated for in money damages and  would cause irreparable injury to TAILGATEFIX. Accordingly, the RESELLER agrees that TAILGATEFIX is  entitled to, in addition to all other rights and remedies available to it at law or in equity, an injunction  restraining the RESELLER and any agents of the RESELLER, from directly or indirectly committing or  engaging in any act restricted by this Agreement in relation to the Confidential Information.

Notices 

  1. The addresses for any notice to be delivered to any of the parties to this Agreement are as follows:
  2. Banks Morrison Innovations, LLC

Address : 208 Forest Oaks Drive, Clayton, NC 27527 U.S.A.

  1. “Reseller” : ___________________________________________

Address : ______________________________ Phone : __________________

Representations 

  1. In providing the Confidential Information, TAILGATEFIX makes no representations, either expressed or  implied as to its adequacy, sufficiency, completeness, correctness or its lack of defect of any kind,  including any patent or trademark infringement that may result from the use of such information.

Termination 

  1. Either party may terminate this Agreement by providing written notice to the other party. Except as  otherwise provided in this Agreement, all rights and obligations under this Agreement will terminate at  that time.

Assignment 

  1. Except where a party has changed its corporate name or merged with another corporation, this  Agreement may not be assigned or otherwise transferred by either party in whole or part without the  prior written consent of the other party to this Agreement.

Amendments 

  1. This Agreement may only be amended or modified by a written instrument executed by both  TAILGATEFIX and the RESELLER.

Governing Law 

  1. This Agreement shall be governed by and construed in accordance with the laws of the United States of  America, State of North Carolina, without regard to conflicts of laws provisions thereof. Any action or  proceeding must be brought in the federal or state courts located in Wake County, North Carolina, U.S.A.  and each Party hereby consents to the exclusive jurisdiction of, and venue in, such courts with regard  thereto.

General Provisions 

  1. Time is of the essence in this Agreement.
  2. This Agreement may be executed in counterpart.
  3. Headings are inserted for the convenience of the parties only and are not to be considered when  interpreting this Agreement. Words in the singular mean and include the plural and vice versa. Words in  the masculine mean and include the feminine and vice versa.
  4. The clauses, paragraphs, and subparagraphs contained in this Agreement are intended to be read and  construed independently of each other. If any part of this Agreement is held to be invalid, this invalidity  will not affect the operation of any other part of this Agreement.
  5. The RESELLER is liable for all costs, expenses and expenditures including, and without limitation, the  complete legal costs incurred by TAILGATEFIX in enforcing this Agreement as a result of any default of  this Agreement by the RESELLER.
  6. TAILGATEFIX and the RESELLER acknowledge that this Agreement is reasonable, valid and enforceable.  However, if a court of competent jurisdiction finds any of the provisions of this Agreement to be too  broad to be enforceable, it is the intention of TAILGATEFIX and the RESELLER that such provision be  reduced in scope by the court only to the extent deemed necessary by that court to render the provision  reasonable and enforceable, bearing in mind that it is the intention of the RESELLER to give TAILGATEFIX the broadest possible protection to maintain the confidentiality of the Confidential Information.
  7. No failure or delay by TAILGATEFIX in exercising any power, right or privilege provided in this Agreement  will operate as a waiver, nor will any single or partial exercise of such rights, powers or privileges  preclude any further exercise of them or the exercise of any other right, power or privilege provided in  this Agreement.
  8. This Agreement will inure to the benefit of and be binding upon the respective heirs, executors,  administrators, successors and assigns, as the case may be, of TAILGATEFIX and the RESELLER.
  9. This Agreement constitutes the entire agreement between the parties and there are no further items or  provisions, either oral or otherwise.

< SIGNATURES ON NEXT PAGE >

TAILGATEFIX places great value on the efforts of all resellers to represent our Products and support their  customers. Our Agreement terms is/are intended to encourage Confidentiality as it relates to TAILGATEFIX’s  Product details with Resellers, as well as, promote competition for the sale of TAILGATEFIX products in a manner  that is consistent with the long-term interests of our mutual customers.

IN WITNESS WHEREOF ; TAILGATEFIX and the RESELLER have duly affixed their signatures under hand and seal  on this ________ day of ________________, 2020.

TAILGATEFIX: 

BANKS MORRISON INNOVATIONS, LLC

a North Carolina limited liability company

By:

____________________________,   Its: Member Manager;

Address : 208 Forest Oaks Drive, Clayton, NC 27527 Email : [email protected]

 

RESELLER: 

Company : _____________________________

 

Authorized Reseller Representative :

By: _____

Print name : _________________________,

Position/Title : __________________________

Address : _______________________________

_______________________________

Email : _____________________________

Phone : _____________________________