[response]
<p>Name:<br />
[text srf_name /50 id:srf_name tabindex:2]</p>
<p>Company:<br />
[text srf_company /50 id:srf_company tabindex:3]</p>
<p style="margin-bottom: 0">Phone:</p>
<table class="table" id="sr_form_phone" >
<tr class="rowa">
<td class="col1 cell">([text srf_area_code 2/3 id:srf_area_code tabindex:4])</td>
<td class="col2 cell"></td>
<td class="col3 cell">[text srf_phone_prefix 2/3 id:srf_phone_prefix tabindex:5]</td>
<td class="col4 cell">-</td>
<td class="col5 cell">[text srf_phone 4/4 id:srf_phone tabindex:6]</td>
</tr>
<tr class="rowb">
<td class="col1 cell">area code</td>
<td class="col2 cell"></td>
<td class="col3 cell">phone</td>
<td class="col4 cell"></td>
<td class="col5 cell"></td>
</tr>
</table>
<div class="clear"></div>
<p style="margin: 10px 0 -22px 0">Type of Service Needed:</p>
[select srf_type_of_service tabindex:7 id:srf_type_of_service "Service1" "Service2" "Service3" "Other"]
<p style="margin: 10px 0 -22px 0">Contact Me:</p>
[select srf_time_frame tabindex:8 id:srf_time_frame "1 Day" "1 Week" "1 Month"]
<p>[submit id:srf_submit "Submit Request"]</p>