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| <!doctype html public "-//IETF//DTD HTML//EN//2.0"> | |
| <html> | |
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| <meta http-equiv="Content-Type" content="text/html; charset=windows-1252"> | |
| <meta name="Generator" content="Microsoft Publisher 98"> | |
| <meta name="keywords" content="Police, Fire, EMS, Public Safety, Information Technology for Public Safety, Public Safety Software, Computer Aided Dispatch, CAD, Records management, Digital Imaging, Arrest, Arrests, Booking"> | |
| <title>Request Information</title> | |
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| <body bgcolor="#ffffff" link="#0000ff" vlink="#6633cc" text="#000080" background="back.gif" topmargin="0" leftmargin="0"> | |
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| <!--webbot bot="SaveResults" s-email-address="info@pamet.net" s-email-format="TEXT/PRE" b-email-label-fields="TRUE" s-email-Subject="Web site info request" s-builtin-fields="Date Time" b-email-subject-from-field="FALSE" startspan --><strong>[FrontPage Save Results Component]</strong><!--webbot bot="SaveResults" endspan i-checksum="6561" --> | |
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| <p align="center"><center><font face="Arial" color="#000080" size="4">Information Request Form<br></font> | |
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| <p align="left"><font face="Arial" color="#000080" size="1">Please answer the following questions. ADD ANY ADDITIONAL INFORMATION ABOUT YOUR AGENCY IN THE COMMENTS BOX.<br></font> | |
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| <tr> | |
| <td width="3" height="30"></td> | |
| <td width="158" height="30" valign="top" align="left"> | |
| <p align="left"><font face="Arial" color="#000080" size="1">Number of sworn personnel?<br></font> | |
| </td> | |
| <td width="3"></td> | |
| </tr> | |
| </table> | |
| </td> | |
| <td colspan="6"></td> | |
| <td width="324" height="30" colspan="28" rowspan="1" valign="top" align="left"> | |
| <table border="0" cellpadding="0" cellspacing="0"> | |
| <tr> | |
| <td width="3" height="30"></td> | |
| <td width="316" height="30" valign="top" align="left"> | |
| <p align="left"><font face="Arial" color="#000080" size="1">Does your agency currently use a CAD or Records Management system?<br></font> | |
| </td> | |
| <td width="3"></td> | |
| </tr> | |
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| </td> | |
| <td colspan="7"></td> | |
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| <tr> | |
| <td height="6"></td> | |
| <td colspan="48"></td> | |
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| <tr> | |
| <td height="2"></td> | |
| <td colspan="33"></td> | |
| <td width="22" height="12" colspan="2" rowspan="2" valign="top" align="left"> | |
| <input type="radio" name="Currently_have_CAD" value="CAD Only"> | |
| </td> | |
| <td width="129" height="24" colspan="7" rowspan="4" valign="top" align="left"> | |
| <p align="left"><font face="Arial" color="#000080" size="1"> Cad only<br></font> | |
| </td> | |
| <td colspan="6"></td> | |
| </tr> | |
| <tr> | |
| <td height="10"></td> | |
| <td colspan="2"></td> | |
| <td width="22" height="12" colspan="2" rowspan="2" valign="top" align="left"> | |
| <input type="radio" name="Number_of_Personnel" value="5-50"> | |
| </td> | |
| <td width="129" height="25" colspan="3" rowspan="4" valign="top" align="left"> | |
| <p align="left"><font face="Arial" color="#000080" size="1">5-50<br></font> | |
| </td> | |
| <td colspan="7"></td> | |
| <td width="22" height="12" colspan="2" rowspan="2" valign="top" align="left"> | |
| <input type="radio" name="Currently_have_CAD" value="Yes/both"> | |
| </td> | |
| <td width="129" height="25" colspan="13" rowspan="4" valign="top" align="left"> | |
| <p align="left"><font face="Arial" color="#000080" size="1">Yes/ Both<br></font> | |
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| <td colspan="4"></td> | |
| <td colspan="6"></td> | |
| </tr> | |
| <tr> | |
| <td height="2"></td> | |
| <td colspan="2"></td> | |
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| <td colspan="6"></td> | |
| <td colspan="6"></td> | |
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| <tr> | |
| <td height="10"></td> | |
| <td colspan="4"></td> | |
| <td colspan="9"></td> | |
| <td colspan="6"></td> | |
| <td colspan="6"></td> | |
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| <tr> | |
| <td height="3"></td> | |
| <td colspan="4"></td> | |
| <td colspan="9"></td> | |
| <td colspan="19"></td> | |
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| <tr> | |
| <td height="5"></td> | |
| <td colspan="48"></td> | |
| </tr> | |
| <tr> | |
| <td height="4"></td> | |
| <td colspan="2"></td> | |
| <td width="22" height="12" colspan="2" rowspan="2" valign="top" align="left"> | |
| <input type="radio" name="Number_of_personnel" value="51-150"> | |
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| <td width="129" height="25" colspan="3" rowspan="4" valign="top" align="left"> | |
| <p align="left"><font face="Arial" color="#000080" size="1">51-150<br></font> | |
| </td> | |
| <td colspan="41"></td> | |
| </tr> | |
| <tr> | |
| <td height="8"></td> | |
| <td colspan="2"></td> | |
| <td colspan="6"></td> | |
| <td width="22" height="12" colspan="2" rowspan="2" valign="top" align="left"> | |
| <input type="radio" name="Currently_have_CAD" value="Records only"> | |
| </td> | |
| <td width="129" height="24" colspan="13" rowspan="4" valign="top" align="left"> | |
| <p align="left"><font face="Arial" color="#000080" size="1"> Records only<br></font> | |
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| <td colspan="5"></td> | |
| <td width="22" height="12" colspan="2" rowspan="2" valign="top" align="left"> | |
| <input type="radio" name="Currently_have_CAD" value="No"> | |
| </td> | |
| <td width="129" height="24" colspan="7" rowspan="4" valign="top" align="left"> | |
| <p align="left"><font face="Arial" color="#000080" size="1">No<br></font> | |
| </td> | |
| <td colspan="6"></td> | |
| </tr> | |
| <tr> | |
| <td height="4"></td> | |
| <td colspan="4"></td> | |
| <td colspan="6"></td> | |
| <td colspan="5"></td> | |
| <td colspan="6"></td> | |
| </tr> | |
| <tr> | |
| <td height="9"></td> | |
| <td colspan="4"></td> | |
| <td colspan="8"></td> | |
| <td colspan="7"></td> | |
| <td colspan="6"></td> | |
| </tr> | |
| <tr> | |
| <td height="3"></td> | |
| <td colspan="15"></td> | |
| <td colspan="7"></td> | |
| <td colspan="6"></td> | |
| </tr> | |
| <tr> | |
| <td height="2"></td> | |
| <td colspan="48"></td> | |
| </tr> | |
| <tr> | |
| <td height="4"></td> | |
| <td colspan="2"></td> | |
| <td width="22" height="12" colspan="2" rowspan="2" valign="top" align="left"> | |
| <input type="radio" name="Number_of_personnel" value="Over_150"> | |
| </td> | |
| <td width="129" height="25" colspan="3" rowspan="3" valign="top" align="left"> | |
| <p align="left"><font face="Arial" color="#000080" size="1">151+<br></font> | |
| </td> | |
| <td colspan="41"></td> | |
| </tr> | |
| <tr> | |
| <td height="8"></td> | |
| <td colspan="2"></td> | |
| <td colspan="24"></td> | |
| <td width="171" height="36" colspan="12" rowspan="4" valign="top" align="left"> | |
| <table border="0" cellpadding="0" cellspacing="0"> | |
| <tr> | |
| <td width="3" height="36"></td> | |
| <td width="163" height="36" valign="top" align="left"> | |
| <p align="left"><font face="Arial" color="#000080" size="1">CAD/Records System currently used by your Agency <br></font> | |
| </td> | |
| <td width="3"></td> | |
| </tr> | |
| </table> | |
| </td> | |
| <td colspan="5"></td> | |
| </tr> | |
| <tr> | |
| <td height="13"></td> | |
| <td colspan="4"></td> | |
| <td colspan="24"></td> | |
| <td colspan="5"></td> | |
| </tr> | |
| <tr> | |
| <td height="9"></td> | |
| <td colspan="31"></td> | |
| <td colspan="5"></td> | |
| </tr> | |
| <tr> | |
| <td height="6"></td> | |
| <td width="165" height="30" colspan="7" rowspan="3" valign="top" align="left"> | |
| <table border="0" cellpadding="0" cellspacing="0"> | |
| <tr> | |
| <td width="3" height="30"></td> | |
| <td width="158" height="30" valign="top" align="left"> | |
| <p align="left"><font face="Arial" color="#000080" size="1">Would you like to arrange a demo?<br></font> | |
| </td> | |
| <td width="3"></td> | |
| </tr> | |
| </table> | |
| </td> | |
| <td colspan="5"></td> | |
| <td width="165" height="30" colspan="17" rowspan="3" valign="top" align="left"> | |
| <table border="0" cellpadding="0" cellspacing="0"> | |
| <tr> | |
| <td width="3" height="30"></td> | |
| <td width="158" height="30" valign="top" align="left"> | |
| <p align="left"><font face="Arial" color="#000080" size="1">Time frame for acquiring new system<br></font> | |
| </td> | |
| <td width="3"></td> | |
| </tr> | |
| </table> | |
| </td> | |
| <td colspan="2"></td> | |
| <td colspan="5"></td> | |
| </tr> | |
| <tr> | |
| <td height="6"></td> | |
| <td colspan="5"></td> | |
| <td colspan="19"></td> | |
| </tr> | |
| <tr> | |
| <td height="18"></td> | |
| <td colspan="5"></td> | |
| <td colspan="2"></td> | |
| <td width="174" height="116" colspan="13" rowspan="14" valign="top" align="left"> | |
| <textarea name="Current_system_used_by_agency" rows="6" cols="18"></textarea> | |
| </td> | |
| <td colspan="4"></td> | |
| </tr> | |
| <tr> | |
| <td height="8"></td> | |
| <td colspan="31"></td> | |
| <td colspan="4"></td> | |
| </tr> | |
| <tr> | |
| <td height="12"></td> | |
| <td colspan="2"></td> | |
| <td width="22" height="12" colspan="2" rowspan="1" valign="top" align="left"> | |
| <input type="radio" name="Arrange_demo" value="Yes"> | |
| </td> | |
| <td width="129" height="25" colspan="3" rowspan="2" valign="top" align="left"> | |
| <p align="left"><font face="Arial" color="#000080" size="1">Yes<br></font> | |
| </td> | |
| <td colspan="7"></td> | |
| <td width="22" height="12" colspan="2" rowspan="1" valign="top" align="left"> | |
| <input type="radio" name="Question3" value="Answer_A"> | |
| </td> | |
| <td width="129" height="25" colspan="13" rowspan="2" valign="top" align="left"> | |
| <p align="left"><font face="Arial" color="#000080" size="1">Immediate <br></font> | |
| </td> | |
| <td colspan="2"></td> | |
| <td colspan="4"></td> | |
| </tr> | |
| <tr> | |
| <td height="13"></td> | |
| <td colspan="4"></td> | |
| <td colspan="9"></td> | |
| <td colspan="2"></td> | |
| <td colspan="4"></td> | |
| </tr> | |
| <tr> | |
| <td height="5"></td> | |
| <td colspan="31"></td> | |
| <td colspan="4"></td> | |
| </tr> | |
| <tr> | |
| <td height="4"></td> | |
| <td colspan="14"></td> | |
| <td width="22" height="12" colspan="2" rowspan="2" valign="top" align="left"> | |
| <input type="radio" name="Question3" value="Answer_B"> | |
| </td> | |
| <td width="129" height="25" colspan="13" rowspan="4" valign="top" align="left"> | |
| <p align="left"><font face="Arial" color="#000080" size="1">3-6 Months<br></font> | |
| </td> | |
| <td colspan="2"></td> | |
| <td colspan="4"></td> | |
| </tr> | |
| <tr> | |
| <td height="8"></td> | |
| <td></td> | |
| <td width="22" height="12" colspan="2" rowspan="2" valign="top" align="left"> | |
| <input type="radio" name="Arrange_demo" value="No"> | |
| </td> | |
| <td width="129" height="24" colspan="3" rowspan="4" valign="top" align="left"> | |
| <p align="left"><font face="Arial" color="#000080" size="1">No, just send info<br></font> | |
| </td> | |
| <td colspan="8"></td> | |
| <td colspan="2"></td> | |
| <td colspan="4"></td> | |
| </tr> | |
| <tr> | |
| <td height="4"></td> | |
| <td></td> | |
| <td colspan="10"></td> | |
| <td colspan="2"></td> | |
| <td colspan="4"></td> | |
| </tr> | |
| <tr> | |
| <td height="9"></td> | |
| <td colspan="3"></td> | |
| <td colspan="10"></td> | |
| <td colspan="2"></td> | |
| <td colspan="4"></td> | |
| </tr> | |
| <tr> | |
| <td height="3"></td> | |
| <td colspan="3"></td> | |
| <td colspan="25"></td> | |
| <td colspan="4"></td> | |
| </tr> | |
| <tr> | |
| <td height="6"></td> | |
| <td colspan="31"></td> | |
| <td colspan="4"></td> | |
| </tr> | |
| <tr> | |
| <td height="12"></td> | |
| <td colspan="13"></td> | |
| <td width="22" height="12" colspan="2" rowspan="1" valign="top" align="left"> | |
| <input type="radio" name="Question3" value="Answer_C"> | |
| </td> | |
| <td width="129" height="24" colspan="13" rowspan="2" valign="top" align="left"> | |
| <p align="left"><font face="Arial" color="#000080" size="1">Not determined yet<br></font> | |
| </td> | |
| <td colspan="3"></td> | |
| <td colspan="4"></td> | |
| </tr> | |
| <tr> | |
| <td height="12"></td> | |
| <td colspan="15"></td> | |
| <td colspan="3"></td> | |
| <td colspan="4"></td> | |
| </tr> | |
| <tr> | |
| <td height="2"></td> | |
| <td colspan="31"></td> | |
| <td colspan="4"></td> | |
| </tr> | |
| <tr> | |
| <td height="34"></td> | |
| <td colspan="48"></td> | |
| </tr> | |
| <tr> | |
| <td height="23"></td> | |
| <td colspan="10"></td> | |
| <td width="60" height="24" colspan="9" rowspan="2" valign="top" align="left"> | |
| <table border="0" cellpadding="0" cellspacing="0"> | |
| <tr> | |
| <td width="3" height="3"></td> | |
| <td width="52"></td> | |
| <td width="3"></td> | |
| </tr> | |
| <tr> | |
| <td height="16"></td> | |
| <td width="52" height="16" valign="top" align="left"> | |
| <p align="center"><center><font face="Times New Roman" color="#000080" size="2">Name<br></font> | |
| </td> | |
| <td></td> | |
| </tr> | |
| <tr> | |
| <td height="3"></td> | |
| <td colspan="2"></td> | |
| </tr> | |
| </table> | |
| </td> | |
| <td colspan="3"></td> | |
| <td width="304" height="23" colspan="26" rowspan="1" valign="top" align="left"> | |
| <input name="Name" maxlength="255" size="40" type="text" value> | |
| </td> | |
| </tr> | |
| <tr> | |
| <td height="1"></td> | |
| <td colspan="10"></td> | |
| <td colspan="29"></td> | |
| </tr> | |
| <tr> | |
| <td height="12"></td> | |
| <td colspan="48"></td> | |
| </tr> | |
| <tr> | |
| <td height="21"></td> | |
| <td colspan="10"></td> | |
| <td width="59" height="21" colspan="8" rowspan="1" valign="top" align="left"> | |
| <table border="0" cellpadding="0" cellspacing="0"> | |
| <tr> | |
| <td width="3" height="3"></td> | |
| <td width="51"></td> | |
| <td width="3"></td> | |
| </tr> | |
| <tr> | |
| <td height="13"></td> | |
| <td width="51" height="13" valign="top" align="left"> | |
| <p align="right"><font face="Arial" color="#000080" size="1">Agency <br></font> | |
| </td> | |
| <td></td> | |
| </tr> | |
| <tr> | |
| <td height="3"></td> | |
| <td colspan="2"></td> | |
| </tr> | |
| </table> | |
| </td> | |
| <td colspan="4"></td> | |
| <td width="304" height="23" colspan="26" rowspan="2" valign="top" align="left"> | |
| <input name="Agency_name" maxlength="255" size="40" type="text" value> | |
| </td> | |
| </tr> | |
| <tr> | |
| <td height="2"></td> | |
| <td colspan="22"></td> | |
| </tr> | |
| <tr> | |
| <td height="7"></td> | |
| <td colspan="48"></td> | |
| </tr> | |
| <tr> | |
| <td height="21"></td> | |
| <td colspan="9"></td> | |
| <td width="59" height="21" colspan="8" rowspan="1" valign="top" align="left"> | |
| <table border="0" cellpadding="0" cellspacing="0"> | |
| <tr> | |
| <td width="3" height="3"></td> | |
| <td width="51"></td> | |
| <td width="3"></td> | |
| </tr> | |
| <tr> | |
| <td height="13"></td> | |
| <td width="51" height="13" valign="top" align="left"> | |
| <p align="right"><font face="Arial" color="#000080" size="1">Address:<br></font> | |
| </td> | |
| <td></td> | |
| </tr> | |
| <tr> | |
| <td height="3"></td> | |
| <td colspan="2"></td> | |
| </tr> | |
| </table> | |
| </td> | |
| <td colspan="4"></td> | |
| <td width="304" height="23" colspan="26" rowspan="2" valign="top" align="left"> | |
| <input name="Address_Line1" maxlength="255" size="40" type="text" value> | |
| </td> | |
| <td></td> | |
| </tr> | |
| <tr> | |
| <td height="2"></td> | |
| <td colspan="21"></td> | |
| <td></td> | |
| </tr> | |
| <tr> | |
| <td height="8"></td> | |
| <td colspan="48"></td> | |
| </tr> | |
| <tr> | |
| <td height="22"></td> | |
| <td colspan="9"></td> | |
| <td width="59" height="22" colspan="8" rowspan="1" valign="top" align="left"> | |
| <table border="0" cellpadding="0" cellspacing="0"> | |
| <tr> | |
| <td width="3" height="3"></td> | |
| <td width="51"></td> | |
| <td width="3"></td> | |
| </tr> | |
| <tr> | |
| <td height="13"></td> | |
| <td width="51" height="13" valign="top" align="left"> | |
| <p align="right"><font face="Arial" color="#000080" size="1">City:<br></font> | |
| </td> | |
| <td></td> | |
| </tr> | |
| <tr> | |
| <td height="3"></td> | |
| <td colspan="2"></td> | |
| </tr> | |
| </table> | |
| </td> | |
| <td colspan="3"></td> | |
| <td width="115" height="23" colspan="10" rowspan="2" valign="top" align="left"> | |
| <input name="City" maxlength="255" size="13" type="text" value> | |
| </td> | |
| <td colspan="2"></td> | |
| <td width="91" height="22" colspan="7" rowspan="1" valign="top" align="left"> | |
| <table border="0" cellpadding="0" cellspacing="0"> | |
| <tr> | |
| <td width="3" height="3"></td> | |
| <td width="83"></td> | |
| <td width="3"></td> | |
| </tr> | |
| <tr> | |
| <td height="13"></td> | |
| <td width="83" height="13" valign="top" align="left"> | |
| <p align="right"><font face="Arial" color="#000080" size="1">State/Prov:<br></font> | |
| </td> | |
| <td></td> | |
| </tr> | |
| <tr> | |
| <td height="3"></td> | |
| <td colspan="2"></td> | |
| </tr> | |
| </table> | |
| </td> | |
| <td></td> | |
| <td width="80" height="23" colspan="8" rowspan="2" valign="top" align="left"> | |
| <input name="State_Province" maxlength="255" size="8" type="text" value> | |
| </td> | |
| </tr> | |
| <tr> | |
| <td height="1"></td> | |
| <td colspan="20"></td> | |
| <td colspan="10"></td> | |
| </tr> | |
| <tr> | |
| <td height="8"></td> | |
| <td colspan="48"></td> | |
| </tr> | |
| <tr> | |
| <td height="1"></td> | |
| <td colspan="9"></td> | |
| <td width="59" height="22" colspan="8" rowspan="2" valign="top" align="left"> | |
| <table border="0" cellpadding="0" cellspacing="0"> | |
| <tr> | |
| <td width="3" height="3"></td> | |
| <td width="51"></td> | |
| <td width="3"></td> | |
| </tr> | |
| <tr> | |
| <td height="13"></td> | |
| <td width="51" height="13" valign="top" align="left"> | |
| <p align="right"><font face="Arial" color="#000080" size="1">Country:<br></font> | |
| </td> | |
| <td></td> | |
| </tr> | |
| <tr> | |
| <td height="3"></td> | |
| <td colspan="2"></td> | |
| </tr> | |
| </table> | |
| </td> | |
| <td colspan="15"></td> | |
| <td width="91" height="22" colspan="7" rowspan="2" valign="top" align="left"> | |
| <table border="0" cellpadding="0" cellspacing="0"> | |
| <tr> | |
| <td width="3" height="3"></td> | |
| <td width="83"></td> | |
| <td width="3"></td> | |
| </tr> | |
| <tr> | |
| <td height="13"></td> | |
| <td width="83" height="13" valign="top" align="left"> | |
| <p align="right"><font face="Arial" color="#000080" size="1">Zip/Post. code:<br></font> | |
| </td> | |
| <td></td> | |
| </tr> | |
| <tr> | |
| <td height="3"></td> | |
| <td colspan="2"></td> | |
| </tr> | |
| </table> | |
| </td> | |
| <td colspan="9"></td> | |
| </tr> | |
| <tr> | |
| <td height="21"></td> | |
| <td colspan="9"></td> | |
| <td colspan="3"></td> | |
| <td width="115" height="23" colspan="10" rowspan="2" valign="top" align="left"> | |
| <input name="Country" maxlength="255" size="13" type="text" value> | |
| </td> | |
| <td colspan="2"></td> | |
| <td></td> | |
| <td width="80" height="23" colspan="8" rowspan="2" valign="top" align="left"> | |
| <input name="Zip_PostalCode" maxlength="255" size="8" type="text" value> | |
| </td> | |
| </tr> | |
| <tr> | |
| <td height="2"></td> | |
| <td colspan="20"></td> | |
| <td colspan="10"></td> | |
| </tr> | |
| <tr> | |
| <td height="6"></td> | |
| <td colspan="48"></td> | |
| </tr> | |
| <tr> | |
| <td height="22"></td> | |
| <td colspan="9"></td> | |
| <td width="59" height="22" colspan="8" rowspan="1" valign="top" align="left"> | |
| <table border="0" cellpadding="0" cellspacing="0"> | |
| <tr> | |
| <td width="3" height="3"></td> | |
| <td width="51"></td> | |
| <td width="3"></td> | |
| </tr> | |
| <tr> | |
| <td height="13"></td> | |
| <td width="51" height="13" valign="top" align="left"> | |
| <p align="right"><font face="Arial" color="#000080" size="1">Phone:<br></font> | |
| </td> | |
| <td></td> | |
| </tr> | |
| <tr> | |
| <td height="3"></td> | |
| <td colspan="2"></td> | |
| </tr> | |
| </table> | |
| </td> | |
| <td colspan="4"></td> | |
| <td width="304" height="23" colspan="26" rowspan="2" valign="top" align="left"> | |
| <input name="Phone" maxlength="255" size="40" type="text" value> | |
| </td> | |
| <td></td> | |
| </tr> | |
| <tr> | |
| <td height="1"></td> | |
| <td colspan="21"></td> | |
| <td></td> | |
| </tr> | |
| <tr> | |
| <td height="9"></td> | |
| <td colspan="48"></td> | |
| </tr> | |
| <tr> | |
| <td height="21"></td> | |
| <td colspan="9"></td> | |
| <td width="59" height="21" colspan="8" rowspan="1" valign="top" align="left"> | |
| <table border="0" cellpadding="0" cellspacing="0"> | |
| <tr> | |
| <td width="3" height="3"></td> | |
| <td width="51"></td> | |
| <td width="3"></td> | |
| </tr> | |
| <tr> | |
| <td height="13"></td> | |
| <td width="51" height="13" valign="top" align="left"> | |
| <p align="right"><font face="Arial" color="#000080" size="1">E-mail:<br></font> | |
| </td> | |
| <td></td> | |
| </tr> | |
| <tr> | |
| <td height="3"></td> | |
| <td colspan="2"></td> | |
| </tr> | |
| </table> | |
| </td> | |
| <td colspan="4"></td> | |
| <td width="304" height="23" colspan="26" rowspan="2" valign="top" align="left"> | |
| <input name="Email" maxlength="255" size="40" type="text" value> | |
| </td> | |
| <td></td> | |
| </tr> | |
| <tr> | |
| <td height="2"></td> | |
| <td colspan="21"></td> | |
| <td></td> | |
| </tr> | |
| <tr> | |
| <td height="3"></td> | |
| <td colspan="48"></td> | |
| </tr> | |
| <tr> | |
| <td height="18"></td> | |
| <td colspan="12"></td> | |
| <td width="356" height="18" colspan="34" rowspan="1" valign="top" align="left"> | |
| <table border="0" cellpadding="0" cellspacing="0"> | |
| <tr> | |
| <td width="3" height="18"></td> | |
| <td width="348" height="18" valign="top" align="left"> | |
| <p align="left"><font face="Arial" color="#000080" size="1">Comments:<br></font> | |
| </td> | |
| <td width="3"></td> | |
| </tr> | |
| </table> | |
| </td> | |
| <td colspan="2"></td> | |
| </tr> | |
| <tr> | |
| <td height="10"></td> | |
| <td colspan="48"></td> | |
| </tr> | |
| <tr> | |
| <td height="101"></td> | |
| <td colspan="11"></td> | |
| <td width="366" height="101" colspan="37" rowspan="1" valign="top" align="left"> | |
| <textarea name="Comments" rows="5" cols="42"></textarea> | |
| </td> | |
| </tr> | |
| <tr> | |
| <td height="21"></td> | |
| <td colspan="48"></td> | |
| </tr> | |
| <tr> | |
| <td height="23"></td> | |
| <td colspan="23"></td> | |
| <td width="65" height="23" colspan="2" rowspan="1" valign="top" align="left"> | |
| <input value="Submit" type="submit"> | |
| </td> | |
| <td colspan="10"></td> | |
| <td width="58" height="23" colspan="3" rowspan="1" valign="top" align="left"> | |
| <input value="Reset" type="reset"> | |
| </td> | |
| <td colspan="10"></td> | |
| </tr> | |
| <tr> | |
| <td height="43"></td> | |
| <td colspan="48"></td> | |
| </tr> | |
| <tr> | |
| <td height="165"></td> | |
| <td colspan="5"></td> | |
| <td width="210" height="165" colspan="21" rowspan="1" valign="top" align="left"> | |
| <table border="0" cellpadding="0" cellspacing="0"> | |
| <tr> | |
| <td width="3" height="3"></td> | |
| <td width="202"></td> | |
| <td width="3"></td> | |
| </tr> | |
| <tr> | |
| <td height="158"></td> | |
| <td width="202" height="158" valign="top" align="left"> | |
| <p align="center"><center><font face="Futura T" color="#000080" size="3"><b>Corporate Headquarters<br><center>1000 Main Street <br><center>Acton, Massachusetts 01720<br><center>Phone: 800-538-7128 (US)<br><center> 978-263-2060 (MA)<br><center>Fax: 978-263-4158<br><center></b></font><font face="Arial" size="3"><b>Email: <a href="mailto:info@pamet.net">Info@pamet.net</a></b></font><font face="Times New Roman" size="3"><br></font> | |
| </td> | |
| <td></td> | |
| </tr> | |
| <tr> | |
| <td height="3"></td> | |
| <td colspan="2"></td> | |
| </tr> | |
| </table> | |
| </td> | |
| <td></td> | |
| <td width="206" height="165" colspan="21" rowspan="1" valign="top" align="left"> | |
| <table border="0" cellpadding="0" cellspacing="0"> | |
| <tr> | |
| <td width="3" height="3"></td> | |
| <td width="198"></td> | |
| <td width="3"></td> | |
| </tr> | |
| <tr> | |
| <td height="158"></td> | |
| <td width="198" height="158" valign="top" align="left"> | |
| <p align="center"><center><font face="Futura T" color="#000080" size="3"><b>Sales Office<br><center>101 Southhall Lane<br><center>Suite 400<br><center>Maitland, Florida 32751<br><center>Phone: 800-538-7128 (US) <br><center>407-667-4863 (FL)<br><center>Fax: 407-667-4851<br></b></font> | |
| </td> | |
| <td></td> | |
| </tr> | |
| <tr> | |
| <td height="3"></td> | |
| <td colspan="2"></td> | |
| </tr> | |
| </table> | |
| </td> | |
| </tr> | |
| <tr> | |
| <td height="26"></td> | |
| <td colspan="48"></td> | |
| </tr> | |
| <tr> | |
| <td height="112"></td> | |
| <td colspan="24"></td> | |
| <td width="140" height="112" colspan="13" rowspan="1" valign="top" align="left"> | |
| <img width="140" height="112" border="0" src="img12.gif"></td> | |
| <td colspan="11"></td> | |
| </tr> | |
| </table> | |
| <a name="bottom"></a> | |
| </form> | |
| </body> | |
| </html> |