User Information and Request Form

HIGHLAND MILLS INCORPORATED
340 East 16th Street - P.O. Box 33775 - Charlotte, NC 28233
Phone: 704-375-3333 Fax: 704-342-0391

Personal Information Registration

* REQUIRED FIELDS
* First Name Middle Initial
* Last Name
Job Title
Company Name
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
* Phone #
Fax #
* E-mail Address
Please complete the above information as thoroughly as possible so that we can insure proper delivery of any information you might request from us.
Information Request Form

A request for more information will be sent directly to our Sales Department. You may fill in your comments in the space below or you may pre-select a product or topic to gain more information. Once you have made your selections and/or typed in your message, simply click on the SUBMIT button to send the request. You will receive a response within 2 business days

I am a…
(select all that apply)

Distributor/wholesaler
Salesman
Retailer
Consumer
Other

We can best serve you if you include the following information…
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See samples
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IMPORTANT:
Please enter as specific a request as possible in the space below. This will allow us to send you the information that will be most useful to you. You do not need to enter your name address/information if you have already. Register with us now.

Enter your request on the lines below and then SUBMIT.

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HIGHLAND MILLS INCORPORATED
340 East 16th Street - P.O. Box 33775 - Charlotte, NC 28233
Email: Click Here Phone: 704-375-3333 Fax: 704-342-0391