From: <bre...@pr...> - 2006-02-21 14:56:58
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<html> <head> <meta name=3D"GENERATOR" content=3D"Microsoft FrontPage 5.0"> <meta name=3D"ProgId" content=3D"FrontPage.Editor.Document"> <meta http-equiv=3D"Content-Type" content=3D"text/html; charset=3Dwindows-12= 52"> <title>To request a phone call</title> <style> <!-- .input1 { font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 11px; color: #333333; } --> </style> </head> <body> <table cellSpacing=3D"1" cellPadding=3D"0" width=3D"100" align=3D"center" bg= Color=3D"#000000" border=3D"0"> <tr> <td bgColor=3D"#ffffff"> <table cellSpacing=3D"0" cellPadding=3D"0" width=3D"750" align=3D"center= " border=3D"0"> <tr align=3D"right" bgColor=3D"#fedc0b"> <td colSpan=3D"3" height=3D"23"> <font face=3D"Arial, Helvetica, sans-serif" style=3D"font-family: Ar= ial, Helvetica, sans-serif; font-size: 11px"> <strong>To request a phone call, please complete the form below!&nbs= p; </strong></font></td> </tr> <tr> <td> <img alt src=3D"http://69.94.114.109/Breadstreet_resturant/images/in= dex_r2_c1.jpg" border=3D"0" name=3D"index_r2_c1" width=3D"230" height=3D"93"= ></td> <td> <img alt src=3D"http://69.94.114.109/Breadstreet_resturant/images/in= dex_r2_c2.jpg" border=3D"0" name=3D"index_r2_c2" width=3D"228" height=3D"93"= ></td> <form name=3D"form1" onsubmit=3D"Javascript:return check();" action= =3D"http://69.94.114.109/Breadstreet_resturant/index_submit.asp" method=3D"p= ost"> <td vAlign=3D"top" align=3D"right" width=3D"292" height=3D"427" ro= wSpan=3D"4"> <table cellSpacing=3D"0" cellPadding=3D"0" width=3D"280" border=3D= "0"> <tr> <td colSpan=3D"2"> <font color=3D"#cc3300" style=3D"font-family: Arial, Helvetica= , sans-serif; font-size: 11px" face=3D"Arial, Helvetica, sans-serif"> (Name, Phone number and e-mail address are required fields*)<s= trong> </strong></font></td> </tr> <tr> <td width=3D"138"> <font face=3D"Arial, Helvetica, sans-serif" style=3D"font-fami= ly: Arial, Helvetica, sans-serif; font-size: 11px"> Business Owner Name*</font></td> <td width=3D"142"> <font face=3D"Arial, Helvetica, sans-serif" style=3D"font-fami= ly: Arial, Helvetica, sans-serif; font-size: 11px"> <input class=3D"input1" size=3D"15" name=3D"name"> </font></td= > </tr> <tr> <td> <font face=3D"Arial, Helvetica, sans-serif" style=3D"font-fami= ly: Arial, Helvetica, sans-serif; font-size: 11px"> Company Name</font></td> <td> <font face=3D"Arial, Helvetica, sans-serif" style=3D"font-fami= ly: Arial, Helvetica, sans-serif; font-size: 11px"> <input class=3D"input1" size=3D"15" name=3D"company"> </font><= /td> </tr> <tr> <td> <font face=3D"Arial, Helvetica, sans-serif" style=3D"font-fami= ly: Arial, Helvetica, sans-serif; font-size: 11px"> Phone Number 1*</font></td> <td> <font face=3D"Arial, Helvetica, sans-serif" style=3D"font-fami= ly: Arial, Helvetica, sans-serif; font-size: 11px"> <input class=3D"input1" size=3D"15" name=3D"phone1"> </font></= td> </tr> <tr> <td> <font face=3D"Arial, Helvetica, sans-serif" style=3D"font-fami= ly: Arial, Helvetica, sans-serif; font-size: 11px"> Phone Number 2 (cell)</font></td> <td> <font face=3D"Arial, Helvetica, sans-serif" style=3D"font-fami= ly: Arial, Helvetica, sans-serif; font-size: 11px"> <input class=3D"input1" size=3D"15" name=3D"phone2"> </font></= td> </tr> <tr> <td> <font face=3D"Arial, Helvetica, sans-serif" style=3D"font-fami= ly: Arial, Helvetica, sans-serif; font-size: 11px"> E-mail Address*</font></td> <td> <font face=3D"Arial, Helvetica, sans-serif" style=3D"font-fami= ly: Arial, Helvetica, sans-serif; font-size: 11px"> <input class=3D"input1" size=3D"15" name=3D"email"> </font></t= d> </tr> <tr> <td> <font face=3D"Arial, Helvetica, sans-serif" style=3D"font-fami= ly: Arial, Helvetica, sans-serif; font-size: 11px"> Business Street Address</font></td> <td> <font face=3D"Arial, Helvetica, sans-serif" style=3D"font-fami= ly: Arial, Helvetica, sans-serif; font-size: 11px"> <input class=3D"input1" size=3D"15" name=3D"street"> </font></= td> </tr> <tr> <td> <font face=3D"Arial, Helvetica, sans-serif" style=3D"font-fami= ly: Arial, Helvetica, sans-serif; font-size: 11px"> City/State</font></td> <td> <font face=3D"Arial, Helvetica, sans-serif" style=3D"font-fami= ly: Arial, Helvetica, sans-serif; font-size: 11px"> <input class=3D"input1" size=3D"15" name=3D"city"> </font></td= > </tr> <tr> <td> <font face=3D"Arial, Helvetica, sans-serif" style=3D"font-fami= ly: Arial, Helvetica, sans-serif; font-size: 11px"> Average Monthly Gross Sales (approx.) </font></td> <td> <font face=3D"Arial, Helvetica, sans-serif" style=3D"font-fami= ly: Arial, Helvetica, sans-serif; font-size: 11px"> <input class=3D"input1" size=3D"15" name=3D"gross_sales"> </fo= nt></td> </tr> <tr> <td> <font face=3D"Arial, Helvetica, sans-serif" style=3D"font-fami= ly: Arial, Helvetica, sans-serif; font-size: 11px"> Desired Funding Amount</font></td> <td> <font face=3D"Arial, Helvetica, sans-serif" style=3D"font-fami= ly: Arial, Helvetica, sans-serif; font-size: 11px"> <input class=3D"input1" size=3D"15" name=3D"desired_amount"> <= /font> </td> </tr> <tr> <td> <font face=3D"Arial, Helvetica, sans-serif" style=3D"font-fami= ly: Arial, Helvetica, sans-serif; font-size: 11px"> When do you need the <br> funding by</font></td> <td> <font face=3D"Arial, Helvetica, sans-serif" style=3D"font-fami= ly: Arial, Helvetica, sans-serif; font-size: 11px"> <input class=3D"input1" size=3D"15" name=3D"when_you_need"> </= font></td> </tr> <tr> <td> <font face=3D"Arial, Helvetica, sans-serif" style=3D"font-fami= ly: Arial, Helvetica, sans-serif; font-size: 11px"> How Long have you <br> been in Business</font></td> <td> <font face=3D"Arial, Helvetica, sans-serif" style=3D"font-fami= ly: Arial, Helvetica, sans-serif; font-size: 11px"> <input type=3D"radio" value=3D"Less than one year" name=3D"bus= iness_span">=20 Less than one year<br> <input type=3D"radio" value=3D"Over 1 years" name=3D"business_= span">=20 Over 1 years<br> <input type=3D"radio" value=3D"Over 3 years" name=3D"business_= span">=20 Over 3 years<br> <input type=3D"radio" value=3D"Not opened yet" name=3D"busines= s_span">=20 Not opened yet</font></td> </tr> <tr> <td> <font face=3D"Arial, Helvetica, sans-serif" style=3D"font-fami= ly: Arial, Helvetica, sans-serif; font-size: 11px"> What type of <br> establishment is this?</font></td> <td> <font face=3D"Arial, Helvetica, sans-serif" style=3D"font-fami= ly: Arial, Helvetica, sans-serif; font-size: 11px"> <input type=3D"radio" value=3D"Restaurant" name=3D"establishme= nt_type">=20 Restaurant <input type=3D"radio" value=3D"Retail" name=3D"establishment_t= ype">=20 Retail<br> <input type=3D"radio" value=3D"Hotel" name=3D"establishment_ty= pe"> Hotel <input type=3D"radio" value=3D"Other" name=3D"establishment_ty= pe"> Other</font></td> </tr> <tr> <td> <font face=3D"Arial, Helvetica, sans-serif" style=3D"font-fami= ly: Arial, Helvetica, sans-serif; font-size: 11px"> Best time to contact you</font></td> <td> <font face=3D"Arial, Helvetica, sans-serif" style=3D"font-fami= ly: Arial, Helvetica, sans-serif; font-size: 11px"> <input size=3D"15" name=3D"time_to_contact"> </font></td> </tr> <tr align=3D"middle"> <td colSpan=3D"2"><input type=3D"submit" value=3D"Submit" name= =3D"Submit"></td> </tr> </table> </td> </form> </tr> <tr> <td> <img alt src=3D"http://69.94.114.109/Breadstreet_resturant/images/in= dex_r3_c1.jpg" border=3D"0" name=3D"index_r3_c1" width=3D"230" height=3D"106= "></td> <td> <img alt src=3D"http://69.94.114.109/Breadstreet_resturant/images/in= dex_r3_c2.jpg" border=3D"0" name=3D"index_r3_c2" width=3D"228" height=3D"106= "></td> </tr> <tr> <td> <img alt src=3D"http://69.94.114.109/Breadstreet_resturant/images/in= dex_r4_c1.jpg" border=3D"0" name=3D"index_r4_c1" width=3D"230" height=3D"109= "></td> <td> <img alt src=3D"http://69.94.114.109/Breadstreet_resturant/images/in= dex_r4_c2.jpg" border=3D"0" name=3D"index_r4_c2" width=3D"228" height=3D"109= "></td> </tr> <tr> <td> <img alt src=3D"http://69.94.114.109/Breadstreet_resturant/images/in= dex_r5_c1.jpg" border=3D"0" name=3D"index_r5_c1" width=3D"230" height=3D"119= "></td> <td> <img alt src=3D"http://69.94.114.109/Breadstreet_resturant/images/in= dex_r5_c2.jpg" border=3D"0" name=3D"index_r5_c2" width=3D"228" height=3D"119= "></td> </tr> </table> </td> </tr> </table> </body> </html> |