GLUMP INFORMATION REQUEST FORM

Name:__________________

Address:____________________

____________________

Phone Number:(___)____-______

E-mail Address:_______________

I would like to request information about:

□ Glump Classic

□ Nuclear Glump

□ Safari Glump

□ Iranian Glump

□ GI JOE Glump

□ Pirate Glump

□ Hacker Glump

□ Glump Accessories

Send form to:

GLUMP Industries

126 EZ Lane

Omegant, AP 51947