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web-hack-mirror/mirror/2000/05/06/www.govrcd.com/feedbkfr.htm

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<!DOCTYPE HTML PUBLIC "-//IETF//DTD HTML//EN">
<html>
<head>
<meta name="GENERATOR" content="Microsoft FrontPage 3.0">
<title>GRS Feedback Page</title>
<meta name="Microsoft Theme" content="blends 111, default">
</head>
<body stylesrc="_private/style.htm" background="_themes/blends/blegtext.gif" bgcolor="#FFFFFF" text="#000000" link="#993300" vlink="#0000FF" alink="#FF9900"><!--mstheme--><font face="Trebuchet MS, Arial, Helvetica">
<p><img src="images/feedback.jpg" alt="[Banner Image]" border="0" WIDTH="399" HEIGHT="45"><img src="images/starbkg.gif" align="right" hspace="0" WIDTH="235" HEIGHT="234"> </p>
<p><font color="#0000FF" size="6">Information Request Form</font></p>
<form method="POST" action="_vti_bin/shtml.dll/feedbkfr.htm" webbot-action="--WEBBOT-SELF--" onSubmit="">
<!--webbot bot="SaveResults" U-File="_private/inforeq.htm" S-Format="HTML/DL" S-Label-Fields="TRUE" B-Reverse-Chronology="TRUE" S-Builtin-Fields="REMOTE_NAME" startspan --><input TYPE="hidden" NAME="VTI-GROUP" VALUE="0"><!--webbot bot="SaveResults" endspan i-checksum="43374" --><h3><!--mstheme--><font color="#0000FF"><font size="3">Please request information or comment
about our web site, company, products, or services. If you provide us with your contact
information, we will be able to respond to your requests and comments.</font><!--mstheme--></font></h3>
<p><font size="3">Select the items that apply, and then let us know how to contact you.</font></p>
<p><font size="3"><input type="checkbox" checked name="SendProductLiterature" value="ON">
Send product literature<br>
<input type="checkbox" name="SendCompanyLiterature" value="ON"> Send company literature<br>
<input type="checkbox" name="SalesContactRequested" value="ON"> Have a salesperson contact
me</font></p>
<h3><!--mstheme--><font color="#0000FF">Comments<!--mstheme--></font></h3>
<blockquote>
<p><textarea name="Comments" rows="5" cols="45"></textarea> </p>
</blockquote>
<h3><!--mstheme--><font color="#0000FF">Category<!--mstheme--></font></h3>
<blockquote>
<p><select name="Category" size="1">
<option selected>Web site</option>
<option>Company</option>
<option>Products</option>
<option>Services</option>
</select> </p>
</blockquote>
<h3><!--mstheme--><font color="#0000FF">Contact Information<!--mstheme--></font></h3>
<!--mstheme--></font><table border="0" cellspacing="0">
<tr>
<td><!--mstheme--><font face="Trebuchet MS, Arial, Helvetica"><div align="right"><p><strong><font size="3"><em>Name</em></font></strong><!--mstheme--></font></td>
<td><!--mstheme--><font face="Trebuchet MS, Arial, Helvetica"><font size="3"><input type="text" size="20" name="Name"> </font><!--mstheme--></font></td>
</tr>
<tr>
<td><!--mstheme--><font face="Trebuchet MS, Arial, Helvetica"><div align="right"><p><strong><font size="3"><em>Title</em></font></strong><!--mstheme--></font></td>
<td><!--mstheme--><font face="Trebuchet MS, Arial, Helvetica"><font size="3"><input type="text" size="20" name="Title"> </font><!--mstheme--></font></td>
</tr>
<tr>
<td><!--mstheme--><font face="Trebuchet MS, Arial, Helvetica"><div align="right"><p><strong><font size="3"><em>Company</em></font></strong><!--mstheme--></font></td>
<td><!--mstheme--><font face="Trebuchet MS, Arial, Helvetica"><font size="3"><input type="text" size="20" name="Company"> </font><!--mstheme--></font></td>
</tr>
<tr>
<td><!--mstheme--><font face="Trebuchet MS, Arial, Helvetica"><div align="right"><p><strong><font size="3"><em>Address</em></font></strong><!--mstheme--></font></td>
<td><!--mstheme--><font face="Trebuchet MS, Arial, Helvetica"><font size="3"><textarea name="Address" rows="5" cols="35"></textarea> </font><!--mstheme--></font></td>
</tr>
<tr>
<td><!--mstheme--><font face="Trebuchet MS, Arial, Helvetica"><div align="right"><p><strong><font size="3"><em>E-mail</em></font></strong><!--mstheme--></font></td>
<td><!--mstheme--><font face="Trebuchet MS, Arial, Helvetica"><font size="3"><input type="text" size="20" name="Email"> </font><!--mstheme--></font></td>
</tr>
<tr>
<td><!--mstheme--><font face="Trebuchet MS, Arial, Helvetica"><div align="right"><p><strong><font size="3"><em>Phone</em></font></strong><!--mstheme--></font></td>
<td><!--mstheme--><font face="Trebuchet MS, Arial, Helvetica"><font size="3"><input type="text" size="20" name="Phone"> </font><!--mstheme--></font></td>
</tr>
</table><!--mstheme--><font face="Trebuchet MS, Arial, Helvetica">
<p><input type="submit" value="Submit Feedback"> <input type="reset" value="Reset Form"> </p>
</form>
<p>&nbsp;</p>
<!--mstheme--></font></body>
</html>