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- <FORM Name=”WEB2LEAD” method=”POST” OnSubmit=”return CreateAction()”>
- <SCRIPT>function CreateAction()
- {if (document.WEB2LEAD.SELECTWorkFlow == null)document.WEB2LEAD.action = “https://midwestconstructionproductscorp.applianzsystem.com/CRMMCP/eware.dll/SubmitLead?RuleID=”;else document.WEB2LEAD.action = “https://midwestconstructionproductscorp.applianzsystem.com/CRMMCP/eware.dll/SubmitLead?RuleID=” + document.WEB2LEAD.SELECTWorkFlow.options[document.WEB2LEAD.SELECTWorkFlow.selectedIndex].value;return true;
- }
- </SCRIPT>
- <TABLE WIDTH=580 CLASS=CONTENT>
- <TR>
- <TD width=”580″ height=”50″ VALIGN=TOP ><h3>Contact Us</h3></TD>
- </TR>
- <TR>
- <TD width=”580″ height=”50″ VALIGN=TOP ><SPAN ID=_Captlead_personfirstname class=VIEWBOXCAPTION>First Name:</SPAN>
- <BR><SPAN ID=_Datalead_personfirstname class=VIEWBOX ><input name=”lead_personfirstname” type=”text” CLASS=EDIT ID=”lead_personfirstname” value=”” size=”60″ maxlength=30><input type=hidden name=_HIDDENlead_personfirstname value=””><span CLASS=VIEWBOXNOBG><font color=”red” >*</font></span></SPAN>
- </TD>
- </TR>
- <TR>
- <TD width=”580″ height=”50″ VALIGN=TOP ><SPAN ID=_Captlead_personlastname class=VIEWBOXCAPTION>Last Name:</SPAN>
- <BR><SPAN ID=_Datalead_personlastname class=VIEWBOX ><input name=”lead_personlastname” type=”text” CLASS=EDIT ID=”lead_personlastname” value=”” size=”60″ maxlength=30><input type=hidden name=_HIDDENlead_personlastname value=””><span CLASS=VIEWBOXNOBG><font color=”red” >*</font></span></SPAN>
- </TD>
- </TR>
- <TR>
- <TD width=”580″ height=”50″ VALIGN=TOP ><SPAN ID=_Captlead_companyname class=VIEWBOXCAPTION>Company Name or Residential:</SPAN>
- <BR><SPAN ID=_Datalead_companyname class=VIEWBOX ><input name=”lead_companyname” type=”text” CLASS=EDIT ID=”lead_companyname” value=”” size=”60″ maxlength=60><input type=hidden name=_HIDDENlead_companyname value=””><span CLASS=VIEWBOXNOBG><font color=”red” >*</font></span></SPAN>
- </TD>
- </TR>
- <TR>
- <TD width=”580″ height=”50″ VALIGN=TOP style=”width: 270px” ><SPAN ID=_Captlead_companystate class=VIEWBOXCAPTION>State:</SPAN>
- <BR><SPAN ID=_Datalead_companystate class=VIEWBOX >
- <SELECT class=EDIT size=0 name=”lead_companystate”>
- <OPTION Value=”AL”>Alabama
- </OPTION>
- <OPTION Value=”AK”>Alaska
- </OPTION>
- <OPTION Value=”AZ”>Arizona
- </OPTION>
- <OPTION Value=”AR”>Arkansas
- </OPTION>
- <OPTION Value=”CA”>California
- </OPTION>
- <OPTION Value=”CO”>Colorado
- </OPTION>
- <OPTION Value=”CT”>Connecticut
- </OPTION>
- <OPTION Value=”DE”>Delaware
- </OPTION>
- <OPTION Value=”DC”>District of Columbia
- </OPTION>
- <OPTION Value=”FL”>Florida
- </OPTION>
- <OPTION Value=”GA”>Georgia
- </OPTION>
- <OPTION Value=”HI”>Hawaii
- </OPTION>
- <OPTION Value=”ID”>Idaho
- </OPTION>
- <OPTION Value=”IL”>Illinois
- </OPTION>
- <OPTION Value=”IN”>Indiana
- </OPTION>
- <OPTION Value=”IA”>Iowa
- </OPTION>
- <OPTION Value=”KS”>Kansas
- </OPTION>
- <OPTION Value=”KY”>Kentucky
- </OPTION>
- <OPTION Value=”LA”>Louisiana
- </OPTION>
- <OPTION Value=”ME”>Maine
- </OPTION>
- <OPTION Value=”MD”>Maryland
- </OPTION>
- <OPTION Value=”MA”>Massachusetts
- </OPTION>
- <OPTION Value=”MI”>Michigan
- </OPTION>
- <OPTION Value=”MN”>Minnesota
- </OPTION>
- <OPTION Value=”MS”>Mississippi
- </OPTION>
- <OPTION Value=”MO”>Missouri
- </OPTION>
- <OPTION Value=”MT”>Montana
- </OPTION>
- <OPTION Value=”NE”>Nebraska
- </OPTION>
- <OPTION Value=”NV”>Nevada
- </OPTION>
- <OPTION Value=”NH”>New Hamps<a href='http://www.kriesi.at/contact/customization' target='_blank' rel="nofollow">hire</a>
- </OPTION>
- <OPTION Value=”NJ”>New Jersey
- </OPTION>
- <OPTION Value=”NM”>New Mexico
- </OPTION>
- <OPTION Value=”NY”>New York
- </OPTION>
- <OPTION Value=”NC”>North Carolina
- </OPTION>
- <OPTION Value=”ND”>North Dakota
- </OPTION>
- <OPTION Value=”OH”>Ohio
- </OPTION>
- <OPTION Value=”OK”>Oklahoma
- </OPTION>
- <OPTION Value=”OR”>Oregon
- </OPTION>
- <OPTION Value=”PA”>Pennsylvania
- </OPTION>
- <OPTION Value=”RI”>Rhode Island
- </OPTION>
- <OPTION Value=”SC”>South Carolina
- </OPTION>
- <OPTION Value=”SD”>South Dakota
- </OPTION>
- <OPTION Value=”TN”>Tennessee
- </OPTION>
- <OPTION Value=”TX”>Texas
- </OPTION>
- <OPTION Value=”UT”>Utah
- </OPTION>
- <OPTION Value=”VT”>Vermont
- </OPTION>
- <OPTION Value=”VA”>Virginia
- </OPTION>
- <OPTION Value=”WA”>Washington
- </OPTION>
- <OPTION Value=”WV”>West Virginia
- </OPTION>
- <OPTION Value=”WI”>Wisconsin
- </OPTION>
- <OPTION Value=”WY”>Wyoming
- </OPTION>
- <OPTION Value=”AS”>American Samoa
- </OPTION>
- <OPTION Value=”GU”>Guam
- </OPTION>
- <OPTION Value=”MP”>Northern Mariana Islands
- </OPTION>
- <OPTION Value=”PR”>Puerto Rico
- </OPTION>
- <OPTION Value=”VI”>Virgin Islands
- </OPTION>
- <OPTION Value=”UM”>US Minor Outlying Islands
- </OPTION>
- <OPTION Value=”OC”>Other Country
- </OPTION>
- <OPTION VALUE=”” SELECTED>–None–
- </OPTION>
- </SELECT>
- <input type=hidden name=_HIDDENlead_companystate value=””><span CLASS=VIEWBOXNOBG><font color=”red” >*</font></span></SPAN>
- </TD>
- </TR>
- <TR>
- <TD width=”580″ height=”50″ VALIGN=TOP ><SPAN ID=_Captlead_companypostcode class=VIEWBOXCAPTION>Zip Code:</SPAN>
- <BR><SPAN ID=_Datalead_companypostcode class=VIEWBOX ><input name=”lead_companypostcode” type=”text” CLASS=EDIT ID=”lead_companypostcode” value=”” size=”30″ maxlength=10><input type=hidden name=_HIDDENlead_companypostcode value=””><span CLASS=VIEWBOXNOBG><font color=”red” >*</font></span></SPAN>
- </TD>
- </TR>
- <TR>
- <TD width=”580″ height=”50″ VALIGN=TOP ><SPAN ID=_Captlead_companycountry class=VIEWBOXCAPTION>Country:</SPAN>
- <BR><SPAN ID=_Datalead_companycountry class=VIEWBOX >
- <SELECT class=EDIT size=0 name=”lead_companycountry”>
- <OPTION Value=”AF”>Afghanistan, Islamic State
- </OPTION>
- <OPTION Value=”AL”>Albania
- </OPTION>
- <OPTION Value=”DZ”>Algeria
- </OPTION>
- <OPTION Value=”AS”>American Samoa
- </OPTION>
- <OPTION Value=”AD”>Andorra, Principality of
- </OPTION>
- <OPTION Value=”AO”>Angola
- </OPTION>
- <OPTION Value=”AI”>Anguilla
- </OPTION>
- <OPTION Value=”AQ”>Antarctica
- </OPTION>
- <OPTION Value=”AG”>Antigua and Barbuda
- </OPTION>
- <OPTION Value=”AR”>Argentina
- </OPTION>
- <OPTION Value=”AM”>Armenia
- </OPTION>
- <OPTION Value=”AW”>Aruba
- </OPTION>
- <OPTION Value=”AU”>Australia
- </OPTION>
- <OPTION Value=”AT”>Austria
- </OPTION>
- <OPTION Value=”AZ”>Azerbaidjan
- </OPTION>
- <OPTION Value=”BS”>Bahamas
- </OPTION>
- <OPTION Value=”BH”>Bahrain
- </OPTION>
- <OPTION Value=”BD”>Bangladesh
- </OPTION>
- <OPTION Value=”BB”>Barbados
- </OPTION>
- <OPTION Value=”BY”>Belarus
- </OPTION>
- <OPTION Value=”BE”>Belgium
- </OPTION>
- <OPTION Value=”BZ”>Belize
- </OPTION>
- <OPTION Value=”BJ”>Benin
- </OPTION>
- <OPTION Value=”BM”>Bermuda
- </OPTION>
- <OPTION Value=”BT”>Bhutan
- </OPTION>
- <OPTION Value=”BO”>Bolivia
- </OPTION>
- <OPTION Value=”BA”>Bosnia-Herzegovina
- </OPTION>
- <OPTION Value=”BW”>Botswana
- </OPTION>
- <OPTION Value=”BV”>Bouvet Island
- </OPTION>
- <OPTION Value=”BR”>Brazil
- </OPTION>
- <OPTION Value=”IO”>British Indian Ocean Terr.
- </OPTION>
- <OPTION Value=”BN”>Brunei Darussalam
- </OPTION>
- <OPTION Value=”BG”>Bulgaria
- </OPTION>
- <OPTION Value=”BF”>Burkina Faso
- </OPTION>
- <OPTION Value=”BI”>Burundi
- </OPTION>
- <OPTION Value=”KH”>Cambodia, Kingdom of
- </OPTION>
- <OPTION Value=”CM”>Cameroon
- </OPTION>
- <OPTION Value=”CA”>Canada
- </OPTION>
- <OPTION Value=”CV”>Cape Verde
- </OPTION>
- <OPTION Value=”KY”>Cayman Islands
- </OPTION>
- <OPTION Value=”CF”>Central African Republic
- </OPTION>
- <OPTION Value=”TD”>Chad
- </OPTION>
- <OPTION Value=”CL”>Chile
- </OPTION>
- <OPTION Value=”CN”>China
- </OPTION>
- <OPTION Value=”CX”>Christmas Island
- </OPTION>
- <OPTION Value=”CC”>Cocos (Keeling) Islands
- </OPTION>
- <OPTION Value=”CO”>Colombia
- </OPTION>
- <OPTION Value=”KM”>Comoros
- </OPTION>
- <OPTION Value=”CG”>Congo
- </OPTION>
- <OPTION Value=”CD”>Congo, Democratic Republic
- </OPTION>
- <OPTION Value=”CK”>Cook Islands
- </OPTION>
- <OPTION Value=”CR”>Costa Rica
- </OPTION>
- <OPTION Value=”HR”>Croatia
- </OPTION>
- <OPTION Value=”CU”>Cuba
- </OPTION>
- <OPTION Value=”CY”>Cyprus
- </OPTION>
- <OPTION Value=”CZ”>Czech Republic
- </OPTION>
- <OPTION Value=”DK”>Denmark
- </OPTION>
- <OPTION Value=”DJ”>Djibouti
- </OPTION>
- <OPTION Value=”DM”>Dominica
- </OPTION>
- <OPTION Value=”DO”>Dominican Republic
- </OPTION>
- <OPTION Value=”TP”>East Timor
- </OPTION>
- <OPTION Value=”EC”>Ecuador
- </OPTION>
- <OPTION Value=”EG”>Egypt
- </OPTION>
- <OPTION Value=”SV”>El Salvador
- </OPTION>
- <OPTION Value=”GQ”>Equatorial Guinea
- </OPTION>
- <OPTION Value=”ER”>Eritrea
- </OPTION>
- <OPTION Value=”EE”>Estonia
- </OPTION>
- <OPTION Value=”ET”>Ethiopia
- </OPTION>
- <OPTION Value=”FK”>Falkland Islands
- </OPTION>
- <OPTION Value=”FO”>Faroe Islands
- </OPTION>
- <OPTION Value=”FJ”>Fiji
- </OPTION>
- <OPTION Value=”FI”>Finland
- </OPTION>
- <OPTION Value=”CS”>Former Czechoslovakia
- </OPTION>
- <OPTION Value=”SU”>Former USSR
- </OPTION>
- <OPTION Value=”FR”>France
- </OPTION>
- <OPTION Value=”FX”>France (European Territory)
- </OPTION>
- <OPTION Value=”GF”>French Guyana
- </OPTION>
- <OPTION Value=”TF”>French Southern Territories
- </OPTION>
- <OPTION Value=”GA”>Gabon
- </OPTION>
- <OPTION Value=”GM”>Gambia
- </OPTION>
- <OPTION Value=”GE”>Georgia
- </OPTION>
- <OPTION Value=”DE”>Germany
- </OPTION>
- <OPTION Value=”GH”>Ghana
- </OPTION>
- <OPTION Value=”GI”>Gibraltar
- </OPTION>
- <OPTION Value=”GB”>Great Britain
- </OPTION>
- <OPTION Value=”GR”>Greece
- </OPTION>
- <OPTION Value=”GL”>Greenland
- </OPTION>
- <OPTION Value=”GD”>Grenada
- </OPTION>
- <OPTION Value=”GP”>Guadeloupe (French)
- </OPTION>
- <OPTION Value=”GU”>Guam (USA)
- </OPTION>
- <OPTION Value=”GT”>Guatemala
- </OPTION>
- <OPTION Value=”GN”>Guinea
- </OPTION>
- <OPTION Value=”GW”>Guinea Bissau
- </OPTION>
- <OPTION Value=”GY”>Guyana
- </OPTION>
- <OPTION Value=”HT”>Haiti
- </OPTION>
- <OPTION Value=”HM”>Heard and McDonald Islands
- </OPTION>
- <OPTION Value=”VA”>Holy See (Vatican City)
- </OPTION>
- <OPTION Value=”HN”>Honduras
- </OPTION>
- <OPTION Value=”HK”>Hong Kong
- </OPTION>
- <OPTION Value=”HU”>Hungary
- </OPTION>
- <OPTION Value=”IS”>Iceland
- </OPTION>
- <OPTION Value=”IN”>India
- </OPTION>
- <OPTION Value=”IR”>Iran
- </OPTION>
- <OPTION Value=”IQ”>Iraq
- </OPTION>
- <OPTION Value=”IE”>Ireland
- </OPTION>
- <OPTION Value=”IL”>Israel
- </OPTION>
- <OPTION Value=”IT”>Italy
- </OPTION>
- <OPTION Value=”CI”>Ivory Coast (Cote D’Ivoire)
- </OPTION>
- <OPTION Value=”JM”>Jamaica
- </OPTION>
- <OPTION Value=”JP”>Japan
- </OPTION>
- <OPTION Value=”JO”>Jordan
- </OPTION>
- <OPTION Value=”KZ”>Kazakhstan
- </OPTION>
- <OPTION Value=”KE”>Kenya
- </OPTION>
- <OPTION Value=”KI”>Kiribati
- </OPTION>
- <OPTION Value=”KW”>Kuwait
- </OPTION>
- <OPTION Value=”KG”>Kyrgyz Republic (Kyrgyzstan)
- </OPTION>
- <OPTION Value=”LA”>Laos
- </OPTION>
- <OPTION Value=”LV”>Latvia
- </OPTION>
- <OPTION Value=”LB”>Lebanon
- </OPTION>
- <OPTION Value=”LS”>Lesotho
- </OPTION>
- <OPTION Value=”LR”>Liberia
- </OPTION>
- <OPTION Value=”LY”>Libya
- </OPTION>
- <OPTION Value=”LI”>Liechtenstein
- </OPTION>
- <OPTION Value=”LT”>Lithuania
- </OPTION>
- <OPTION Value=”LU”>Luxembourg
- </OPTION>
- <OPTION Value=”MO”>Macau
- </OPTION>
- <OPTION Value=”MK”>Macedonia
- </OPTION>
- <OPTION Value=”MG”>Madagascar
- </OPTION>
- <OPTION Value=”MW”>Malawi
- </OPTION>
- <OPTION Value=”MY”>Malaysia
- </OPTION>
- <OPTION Value=”MV”>Maldives
- </OPTION>
- <OPTION Value=”ML”>Mali
- </OPTION>
- <OPTION Value=”MT”>Malta
- </OPTION>
- <OPTION Value=”MH”>Marshall Islands
- </OPTION>
- <OPTION Value=”MQ”>Martinique (French)
- </OPTION>
- <OPTION Value=”MR”>Mauritania
- </OPTION>
- <OPTION Value=”MU”>Mauritius
- </OPTION>
- <OPTION Value=”YT”>Mayotte
- </OPTION>
- <OPTION Value=”MX”>Mexico
- </OPTION>
- <OPTION Value=”FM”>Micronesia
- </OPTION>
- <OPTION Value=”MD”>Moldavia
- </OPTION>
- <OPTION Value=”MC”>Monaco
- </OPTION>
- <OPTION Value=”MN”>Mongolia
- </OPTION>
- <OPTION Value=”MS”>Montserrat
- </OPTION>
- <OPTION Value=”MA”>Morocco
- </OPTION>
- <OPTION Value=”MZ”>Mozambique
- </OPTION>
- <OPTION Value=”MM”>Myanmar
- </OPTION>
- <OPTION Value=”NA”>Namibia
- </OPTION>
- <OPTION Value=”NR”>Nauru
- </OPTION>
- <OPTION Value=”NP”>Nepal
- </OPTION>
- <OPTION Value=”NL”>Netherlands
- </OPTION>
- <OPTION Value=”AN”>Netherlands Antilles
- </OPTION>
- <OPTION Value=”NT”>Neutral Zone
- </OPTION>
- <OPTION Value=”NC”>New Caledonia (French)
- </OPTION>
- <OPTION Value=”NZ”>New Zealand
- </OPTION>
- <OPTION Value=”NI”>Nicaragua
- </OPTION>
- <OPTION Value=”NE”>Niger
- </OPTION>
- <OPTION Value=”NG”>Nigeria
- </OPTION>
- <OPTION Value=”NU”>Niue
- </OPTION>
- <OPTION Value=”NF”>Norfolk Island
- </OPTION>
- <OPTION Value=”KP”>North Korea
- </OPTION>
- <OPTION Value=”MP”>Northern Mariana Islands
- </OPTION>
- <OPTION Value=”NO”>Norway
- </OPTION>
- <OPTION Value=”OM”>Oman
- </OPTION>
- <OPTION Value=”PK”>Pakistan
- </OPTION>
- <OPTION Value=”PW”>Palau
- </OPTION>
- <OPTION Value=”PA”>Panama
- </OPTION>
- <OPTION Value=”PG”>Papua New Guinea
- </OPTION>
- <OPTION Value=”PY”>Paraguay
- </OPTION>
- <OPTION Value=”PE”>Peru
- </OPTION>
- <OPTION Value=”PH”>Philippines
- </OPTION>
- <OPTION Value=”PN”>Pitcairn Island
- </OPTION>
- <OPTION Value=”PL”>Poland
- </OPTION>
- <OPTION Value=”PF”>Polynesia (French)
- </OPTION>
- <OPTION Value=”PT”>Portugal
- </OPTION>
- <OPTION Value=”PR”>Puerto Rico
- </OPTION>
- <OPTION Value=”QA”>Qatar
- </OPTION>
- <OPTION Value=”RE”>Reunion (French)
- </OPTION>
- <OPTION Value=”RO”>Romania
- </OPTION>
- <OPTION Value=”RU”>Russian Federation
- </OPTION>
- <OPTION Value=”RW”>Rwanda
- </OPTION>
- <OPTION Value=”GS”>S. Georgia & S. Sandwich Is.
- </OPTION>
- <OPTION Value=”SH”>Saint Helena
- </OPTION>
- <OPTION Value=”KN”>Saint Kitts & Nevis Anguilla
- </OPTION>
- <OPTION Value=”LC”>Saint Lucia
- </OPTION>
- <OPTION Value=”PM”>Saint Pierre and Miquelon
- </OPTION>
- <OPTION Value=”ST”>Saint Tome (Sao Tome)
- </OPTION>
- <OPTION Value=”VC”>Saint Vincent & Grenadines
- </OPTION>
- <OPTION Value=”WS”>Samoa
- </OPTION>
- <OPTION Value=”SM”>San Marino
- </OPTION>
- <OPTION Value=”SA”>Saudi Arabia
- </OPTION>
- <OPTION Value=”SN”>Senegal
- </OPTION>
- <OPTION Value=”SC”>Seychelles
- </OPTION>
- <OPTION Value=”SL”>Sierra Leone
- </OPTION>
- <OPTION Value=”SG”>Singapore
- </OPTION>
- <OPTION Value=”SK”>Slovak Republic
- </OPTION>
- <OPTION Value=”SI”>Slovenia
- </OPTION>
- <OPTION Value=”SB”>Solomon Islands
- </OPTION>
- <OPTION Value=”SO”>Somalia
- </OPTION>
- <OPTION Value=”ZA”>South Africa
- </OPTION>
- <OPTION Value=”KR”>South Korea
- </OPTION>
- <OPTION Value=”ES”>Spain
- </OPTION>
- <OPTION Value=”LK”>Sri Lanka
- </OPTION>
- <OPTION Value=”SD”>Sudan
- </OPTION>
- <OPTION Value=”SR”>Suriname
- </OPTION>
- <OPTION Value=”SJ”>Svalbard and Jan Mayen Is.
- </OPTION>
- <OPTION Value=”SZ”>Swaziland
- </OPTION>
- <OPTION Value=”SE”>Sweden
- </OPTION>
- <OPTION Value=”CH”>Switzerland
- </OPTION>
- <OPTION Value=”SY”>Syria
- </OPTION>
- <OPTION Value=”TJ”>Tadjikistan
- </OPTION>
- <OPTION Value=”TW”>Taiwan
- </OPTION>
- <OPTION Value=”TZ”>Tanzania
- </OPTION>
- <OPTION Value=”TH”>Thailand
- </OPTION>
- <OPTION Value=”TG”>Togo
- </OPTION>
- <OPTION Value=”TK”>Tokelau
- </OPTION>
- <OPTION Value=”TO”>Tonga
- </OPTION>
- <OPTION Value=”TT”>Trinidad and Tobago
- </OPTION>
- <OPTION Value=”TN”>Tunisia
- </OPTION>
- <OPTION Value=”TR”>Turkey
- </OPTION>
- <OPTION Value=”TM”>Turkmenistan
- </OPTION>
- <OPTION Value=”TC”>Turks and Caicos Islands
- </OPTION>
- <OPTION Value=”TV”>Tuvalu
- </OPTION>
- <OPTION Value=”UG”>Uganda
- </OPTION>
- <OPTION Value=”UA”>Ukraine
- </OPTION>
- <OPTION Value=”AE”>United Arab Emirates
- </OPTION>
- <OPTION Value=”UK”>United Kingdom
- </OPTION>
- <OPTION Value=”US”>United States
- </OPTION>
- <OPTION Value=”UY”>Uruguay
- </OPTION>
- <OPTION Value=”UM”>USA Minor Outlying Islands
- </OPTION>
- <OPTION Value=”UZ”>Uzbekistan
- </OPTION>
- <OPTION Value=”VU”>Vanuatu
- </OPTION>
- <OPTION Value=”VE”>Venezuela
- </OPTION>
- <OPTION Value=”VN”>Vietnam
- </OPTION>
- <OPTION Value=”VG”>Virgin Islands (British)
- </OPTION>
- <OPTION Value=”VI”>Virgin Islands (USA)
- </OPTION>
- <OPTION Value=”WF”>Wallis and Futuna Islands
- </OPTION>
- <OPTION Value=”EH”>Western Sahara
- </OPTION>
- <OPTION Value=”YE”>Yemen
- </OPTION>
- <OPTION Value=”YU”>Yugoslavia
- </OPTION>
- <OPTION Value=”ZR”>Zaire
- </OPTION>
- <OPTION Value=”ZM”>Zambia
- </OPTION>
- <OPTION Value=”ZW”>Zimbabwe
- </OPTION>
- <OPTION VALUE=”” SELECTED>–None–
- </OPTION>
- </SELECT>
- <input type=hidden name=_HIDDENlead_companycountry value=””><span CLASS=VIEWBOXNOBG><font color=”red” >*</font></span></SPAN>
- </TD>
- </TR>
- <TR>
- <TD VALIGN=TOP ><SPAN ID=_Captlead_personphonenumber class=VIEWBOXCAPTION>Phone Number:</SPAN>
- <BR><SPAN ID=_Datalead_personphonenumber class=VIEWBOX ><input name=”lead_personphonenumber” type=”text” CLASS=EDIT ID=”lead_personphonenumber” value=”” size=”60″ maxlength=20><input type=hidden name=_HIDDENlead_personphonenumber value=””></SPAN>
- </TD>
- </TR>
- <TR>
- <TD width=”580″ height=”50″ VALIGN=TOP ><SPAN ID=_Captlead_personemail class=VIEWBOXCAPTION>E-mail:</SPAN>
- <BR><SPAN ID=_Datalead_personemail class=VIEWBOX ><input name=”lead_personemail” type=”text” CLASS=EDIT ID=”lead_personemail” value=”” size=”60″ maxlength=30><input type=hidden name=_HIDDENlead_personemail value=””><span CLASS=VIEWBOXNOBG><font color=”red” >*</font></span></SPAN>
- </TD>
- </TR>
- <TD width=”580″ height=”50″ VALIGN=TOP ><SPAN ID=_Captlead_description class=VIEWBOXCAPTION>Description:</SPAN>
- (30 Max Characters)<BR><SPAN ID=_Datalead_description class=VIEWBOX ><input name=”lead_description” type=”text” CLASS=EDIT ID=”lead_description” value=”” size=”60″ maxlength=30><input type=hidden name=_HIDDENlead_description value=””><span CLASS=VIEWBOXNOBG><font color=”red” >*</font></span></SPAN>
- </TD>
- </TR>
- <p><TR>
- <TD width=”580″ height=”175″ VALIGN=TOP ><SPAN ID=_Captlead_details class=VIEWBOXCAPTION>Details:</SPAN>
- <BR><SPAN ID=_Datalead_details class=VIEWBOX ><textarea CLASS=EDIT name=”lead_details” rows=8 cols=50></TEXTAREA><input type=hidden name=_HIDDENlead_details value=””><span CLASS=VIEWBOXNOBG><font color=”red” >*</font></span></SPAN>
- </TD>
- </TR>
- </TABLE>
- <input type=hidden name=_HIDDENlead_source value=”web”><input type=”submit” value=”Save and Submit”><input type=”hidden” name=”RuleID” id=”RuleID” value=””>
- </FORM>
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