<% if(request.getParameter("mail") != null && !request.getParameter("mail").equals("")) { %>
We have received your contact information.
A Pharmaplan representative will contact you shortly. Thank you.
Please visit
www.pharmaplan.com
for more information on other products and services we offer.
<% } else { %>
Please have a Pharmaplan representative contact me...
*
Name:
Title
*
Company Name:
*
Email Address:
*
Phone:
Yes! I authorize Pharmaplan
to add me to their email communications list.
*
= Indicates required fields
<% } %>
© 2006 Pharmaplan
Pharmaplan USA
1823 Mossy Oak Lane
Collieville, TN 38017
Phone: (901) 288-9434
Fax: (508) 485-4973
www.pharmaplan.com
