(English Only) Required fields begin with an asterisk(*) and must be filled in to complete this form. Your Name [*] Your E-mail Address [*] Country [*] Afghanistan Albania Algeria AmericanSamoa Andorra Angola Anguilla Antarctica AntiguaAndBarbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia BosniaAndHerzegowina Botswana BouvetIsland Brazil BritishIndianOceanTerritory BruneiDarussalam Bulgaria BurkinaFaso Burundi Cambodia Cameroon Canada CapeVerde CaymanIslands CentralAfricanRepublic Chad Chile China ChristmasIsland Cocos(Keeling)Islands Colombia Comoros Congo CookIslands CostaRica CoteD'Ivoire Croatia(LocalName:Hrvatska) Cuba Cyprus CzechRepublic Denmark Djibouti Dominica DominicanRepublic EastTimor Ecuador Egypt ElSalvador EquatorialGuinea Eritrea Estonia Ethiopia FalklandIslands(Malvinas) FaroeIslands Fiji Finland France France,Metropolitan FrenchGuiana FrenchPolynesia FrenchSouthernTerritories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti HeardAndMcDonaldIslands Honduras HongKong Hungary Iceland India Indonesia Iran(IslamicRepublicOf) Iraq Ireland Israel Italy Jamaica Japan Japan Jordan Kazakhstan Kenya Kiribati Korea,DemocraticPeople'SRepublicOf Korea,RepublicOf Kuwait Kyrgyzstan LaoPeople'SDemocraticRepublic Latvia Lebanon Lesotho Liberia LibyanArabJamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia,TheFormerYugoslavRepublicOf Madagascar Malawi Malaysia Maldives Mali Malta MarshallIslands Martinique Mauritania Mauritius Mayotte Mexico Micronesia,FederatedStatesOf Moldova,RepublicOf Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands NetherlandsAntilles NewCaledonia NewZealand Nicaragua Niger Nigeria Niue NorfolkIsland NorthernMarianaIslands Norway Oman Pakistan Palau Panama PapuaNewGuinea Paraguay Peru Philippines Pitcairn Poland Portugal PuertoRico Qatar Reunion Romania RussianFederation Rwanda SaintKittsAndNevis SaintLucia SaintVincentAndTheGrenadines Samoa SanMarino SaoTomeAndPrincipe SaudiArabia Senegal Seychelles SierraLeone Singapore Slovakia(SlovakRepublic) Slovenia SolomonIslands Somalia SouthAfrica SouthGeorgiaAndTheSouthSandwichIslands Spain SriLanka St.Helena St.PierreAndMiquelon Sudan Suriname SvalbardAndJanMayenIslands Swaziland Sweden Switzerland SyrianArabRepublic Taiwan,ProvinceOfChina Tajikistan Tanzania,UnitedRepublicOf Thailand Togo Tokelau Tonga TrinidadAndTobago Tunisia Turkey Turkmenistan TurksAndCaicosIslands Tuvalu Uganda Ukraine UnitedArabEmirates UnitedKingdom UnitedStates UnitedStatesMinorOutlyingIslands Uruguay Uzbekistan Vanuatu VaticanCityState(HolySee) Venezuela VietNam VirginIslands(British) VirginIslands(U.S.) WallisAndFutunaIslands WesternSahara Yemen Yugoslavia Zaire Zambia Zimbabwe Your Company Name [*] TEL No. FAX No. Type Of Business [*] distributor dealer installer service/maintenance end user others Subject [*] Message [*]

Copyright (C) 2003 DAIKIN INDUSTRIES, Ltd. All rights reserved.