Hapad, Inc. P.O. Box 6 5301 Enterprise Blvd. Bethel Park, PA 15102 Toll Free: 800.544.2723 Phone: 412.835.1234 Fax: 412.835.6460 E-mail: email@example.com Name * Email * Telephone Comments/Questions * CAPTCHAUsers who receive a hard to read CAPTCHA may use the reload button in the display window to retrieve a new challenge. Generate a new captcha What code is in the image? * Enter the characters shown in the image.