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web-hack-mirror/mirror/2000/08/08/www.tentil.com/request.html

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<HTML>
<HEAD>
<title>tentil.com - Work Request Form</title>
</HEAD>
<body bgcolor="#FFFFFF" text="ff0000" link="FF0000" vlink="darkred">
<center><img src="work.gif" WIDTH="300" HEIGHT="100" ALT="Work request"></center>
<br>
<font face="Arial,Helvetiva" size="-1">
<center><table border="0" cellpadding="0" cellspacing="0" width="60%">
<tr><td valign="0" halign="0" width="60%">
<font face="Arial,Helvetica" size="-1"><CENTER>
Fill out the form below if you are interested in custom graphics<br>
and/or www design, and I'll get back to you with a price estimate.</font></CENTER>
</td></tr>
</table>
<br>
<CENTER><table border="0" cellpadding="6" cellspacing="0">
<FORM METHOD="POST" ACTION="/cgi-bin/bnbform.cgi">
<tr><td bgcolor="#FF0000" colspan="2">
<font face="Arial,Helvetica" size="-1" color="black"><b><center>About You</center></b></font>
</td></tr>
<tr><td valign="0" halign="0" bgcolor="#000000">
<font face="Arial,Helvetica" size="-2" color="FFFFFF">
Your name:</td>
<td bgcolor="#000000">
<input type="text" name="name">
</td></tr>
<tr><td bgcolor="#000000">
<font face="Arial,Helvetica" size="-2" color="FFFFFF">
Your e-mail address:</td>
<td valign="0" halign="0" bgcolor="#000000">
<input type="text" name="submit_by">
</td></tr>
<tr><td " bgcolor="#000000">
<font face="Arial,Helvetica" size="-2" color="FFFFFF">
Your company name:</td>
<td valign="0" halign="0" bgcolor="#000000">
<input type="text" name="company">
</td></tr>
<tr><td bgcolor="000000">
<font face="Arial,Helvetica" size="-2" color="FFFFFF">
Current URL:<br>&nbsp;&nbsp;&nbsp;&nbsp;(if any)</td>
<td bgcolor="#000000">
<input type="text" name="url" value="http://">
</td></tr>
<tr><td bgcolor="#FF000000" colspan="2">
<font face="Arial,Helvetica" size="-1" color="000000"><b><center>About the Design</center></b></font>
</td></tr>
<tr><td bgcolor="#000000">
<font face="Arial,Helvetica" size="-2" color="FFFFFF">
Site type:</td>
<td bgcolor="#000000">
<font face="Arial,Helvetica" size="-2" color="FFFFFF">
<input type="radio" value="business" name="business">Business site<br>
<input type="radio" value="personal" name="personal">Personal site
</font>
</td></tr>
<tr><td bgcolor="#000000">
<font face="Arial,Helvetica" size="-2" color="FFFFFF">
Estimated number of pages:</td>
<td bgcolor="#000000">
<input type="text" name="numberpages" size="3">
</td></tr>
<tr><td bgcolor="000000">
<font face="Arial,Helvetica" size="-2" color="FFFFFF">
Description<br>of the project:</td>
<td bgcolor="#000000">
<textarea name="description" rows="8" cols="35" textwrap="physical"></textarea>
</td></tr>
<tr><td bgcolor="#000000" colspan="2">
<font face="Arial,Helvetica" size="-2" color="FFFFFF">
<center><input type="submit" value="Mail my request!">&nbsp; &nbsp; &nbsp;<input type="reset" value="Clear this form" name="name"></center></td>
</tr>
<!-- SCRIPT CONFIGURATION SECTION -->
<INPUT TYPE="HIDDEN" NAME="required"
VALUE="name,submit_by">
<INPUT TYPE="HIDDEN" NAME="data_order"
VALUE="name,submit_by,company,url,business,personal,
numberpages,description">
<INPUT TYPE="HIDDEN" NAME="submit_to" VALUE="tentil@tentil.com">
<INPUT TYPE="HIDDEN" NAME="form_id" VALUE="Work Request Form">
<INPUT TYPE="HIDDEN" NAME="ok_url"
VALUE="http://www.tentil.com/thanks.html">
<INPUT TYPE="HIDDEN" NAME="not_ok_url"
VALUE="http://www.tentil.com/oops.html">
<!-- END OF SCRIPT CONFIGURATION SECTION -->
</FORM>
</table>
</font>
</body>
</html>