All fields in the form below marked with an asterisks (*) must be filled in.
We have discovered an intermittent issue that, if you fail to fill in a field marked with an asterisks (*) and must go back to fill it in, the form may or may not successfully redirect to a confirmation page (a "Thank You" page) on successful submission. This issue seems to affect the latest version of Microsoft Internet Explorer (version 11 as of this writing) the most.
If you don't get redirected to a "Thank You" confirmation page on submission, please give us a call at (800) 340-4386 and ask for Don to confirm your submission has been received. However, we find submissions usually do go through.
We are working to find a solution to this annoying issue and appologize for the inconvenience.