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Email and Facsimile Consent Form

In order to continue sending valuable product, technical and marketing information via email or fax, Acucorp is requesting your opt-in approval. To ensure that you do not miss any correspondence from us, please complete the following consent form. You can also print out this form and fax it to Acucorp Marketing at (858) 689-4555 or call (800) 262-6585 or (858) 689-4500 and ask to speak with a Marketing representative.

To protect your privacy, Acucorp does not share this information with any third party.

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            Email             Facsimile             Both

No, I would prefer to opt-out of Acucorp's email and facsimile correspondence.
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Acucorp, Inc., 9920 Pacific Heights Blvd., San Diego, CA 92121, +1 858.795.1900
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