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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)
--
_9_
and
small 'E' +1 letters
;
2 chars before small G
and not a
"V",
but
:j:
;
0 chars before small S
followed by