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113 lines
4.9 KiB
113 lines
4.9 KiB
<html>
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<head>
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<title>Local Chamber Site</title>
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<link rel=stylesheet href=/styles/basic.css type=text/css>
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</head>
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<body>
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<table border=0>
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<TR>
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<TD valign="top" width="98%">
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<P align="center"><FONT face="Arial"><SMALL><BR></SMALL><EM><BIG>Request For More Information</BIG></EM></FONT></P>
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<FORM method="POST" action="_vti_bin/shtml.dll/req.htm" webbot-action="--WEBBOT-SELF--">
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<INPUT TYPE="hidden" NAME="VTI-GROUP" VALUE="0"><DIV align="center">
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<CENTER>
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<TABLE border="0" width="80%">
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<TR>
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<TD colspan="3" valign="top">
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<SMALL><FONT face="Arial">I have looked at the Chamber's website but I need more information. I need more information on:</FONT></SMALL>
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</TD>
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</TR>
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<TR>
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<TD valign="top">
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<STRONG><FONT face="Arial"><SMALL><BR>Visiting or Moving to your area</SMALL><BR></FONT></STRONG>
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<P>
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<SMALL><FONT face="Arial">
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<INPUT type="checkbox" name="MovingArea" value="Need Printed Map">I need a printed map of the area.<BR>
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<INPUT type="checkbox" name="MovingArea" value="Need Newcomers Guide">I need a printed Newcomer's Guide for the area
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</FONT></SMALL>
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</TD>
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<TD valign="top"></TD>
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<TD valign="top">
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<STRONG><SMALL><FONT face="Arial">
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<BR>Starting a Business or Moving a Business to your area</FONT></SMALL></STRONG>
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<P><SMALL><FONT face="Arial">
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<INPUT type="checkbox" name="StartingBusiness" value="Need Site And Building Info">
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I need more information about sites and buildings.<BR>
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<INPUT type="checkbox" name="StartingBusiness" value="Need Personal Contact">
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I need someone to contact me for specific answers to my questions.
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</FONT></SMALL></STRONG>
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</TD>
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</TR>
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<TR>
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<TD valign="top"></TD>
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<TD valign="top"></TD>
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<TD valign="top"></TD>
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</TR>
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</TABLE>
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<TABLE border="0" width="80%">
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<TR>
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<TD align="right">
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<STRONG><SMALL><FONT face="Arial"><BR>Name</FONT></SMALL></STRONG>
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</TD>
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<TD>
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<SMALL><FONT face="Arial">
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<BR><INPUT type="text" name="Name" size="30">
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</FONT></SMALL>
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</TD>
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</TR>
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<TR>
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<TD align="right"><STRONG><SMALL><FONT face="Arial">Title</FONT></SMALL></STRONG></TD>
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<TD><SMALL><FONT face="Arial"><INPUT type="text" name="Title" size="30"></FONT></SMALL></TD>
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</TR>
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<TR>
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<TD align="right"><STRONG><SMALL><FONT face="Arial">Company</FONT></SMALL></STRONG></TD>
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<TD><SMALL><FONT face="Arial"><INPUT type="text" name="Company" size="30"></FONT></SMALL></TD>
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</TR>
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<TR>
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<TD align="right"><STRONG><SMALL><FONT face="Arial">Address</FONT></SMALL></STRONG></TD>
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<TD><SMALL><FONT face="Arial"><INPUT type="text" name="Address" size="30"></FONT></SMALL></TD>
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</TR>
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<TR>
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<TD align="right"><STRONG><SMALL><FONT face="Arial">City</FONT></SMALL></STRONG></TD>
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<TD><SMALL><FONT face="Arial"><INPUT type="text" name="City" size="20"></FONT></SMALL></TD>
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</TR>
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<TR>
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<TD align="right"><STRONG><SMALL><FONT face="Arial">State</FONT></SMALL></STRONG></TD>
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<TD><SMALL><FONT face="Arial"><INPUT type="text" name="State" size="20"></FONT></SMALL></TD>
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</TR>
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<TR>
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<TD align="right"><STRONG><SMALL><FONT face="Arial">Zip</FONT></SMALL></STRONG></TD>
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<TD><SMALL><FONT face="Arial"><INPUT type="text" name="Zip" size="15"></FONT></SMALL></TD>
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</TR>
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<TR>
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<TD align="right"><STRONG><SMALL><FONT face="Arial">Phone</FONT></SMALL></STRONG></TD>
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<TD><SMALL><FONT face="Arial"><INPUT type="text" name="Phone" size="15"></FONT></SMALL></TD>
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</TR>
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<TR>
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<TD align="right"><STRONG><SMALL><FONT face="Arial">Fax</FONT></SMALL></STRONG></TD>
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<TD><SMALL><FONT face="Arial"><INPUT type="text" name="Fax" size="15"></FONT></SMALL></TD>
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</TR>
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<TR>
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<TD align="right"><STRONG><SMALL><FONT face="Arial">Email Address</FONT></SMALL></STRONG></TD>
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<TD><SMALL><FONT face="Arial"><INPUT type="text" name="EmailAddress" size="20"></FONT></SMALL></TD>
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</TR>
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<TR>
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<TD align="right"></TD>
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<TD></TD>
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</TR>
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<TR>
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<TD valign="top" align="right"></TD>
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<TD valign="top">
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<SMALL><FONT face="Arial">
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<INPUT type="submit" value="Submit" name="B1"> <INPUT type="reset" value="Reset" name="B2"><BR><BR>
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</FONT></SMALL>
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</TD>
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</TR>
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</TABLE>
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</CENTER>
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</FORM>
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</td>
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</tr>
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</table>
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</body>
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</html>
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