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1 Stacey Road

Danbury, CT 06811

Tel. 203-748-3800
Toll Free: 1-800-792-3183

Fax. 203-748-1472

E-mail: info@theamberroom.net

 

Information Request Form

Please provide the following contact information:

Name

Company

Address

City, St., Zip

Home Phone

Work Phone

Name

E-mail

How did you hear about us?

  Friends
 
Print Ad

  Google

  Yahoo

  Other

I would like information on a:

WEDDING

ANNIVERSARY
BAR/BAT MITZVAH
CORPORATE EVENT
RETIREMENT PARTY
SCHOOL PROM
CHRISTENING

FUNDRAISER

OTHER

If OTHER (Please explain) 

         

Please enter the date of the event

Please enter the time of the event

Please enter the approximate number of guests

When is the best time to contact you?

Morning
Afternoon
Evening

Any Time

What is the best way to contact you?

Phone
E-Mail
Fax

Anyway

 

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