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          <COL WIDTH=95>
          <TR>
            <TD width="1074"><P ALIGN=left class="style1">Customer
              
              Service </P>
                <hr>
                <FORM NAME="ABTECH's Customer Service Form"  METHOD="POST"  action = "cgi-bin\CustomerSurvey.cgi">
                  <INPUT TYPE=HIDDEN NAME="recipient" VALUE="[email protected]">
                  <INPUT TYPE=HIDDEN NAME="subject" VALUE="Feedback from Abtech Website">
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                        <TR VALIGN=TOP>
                          <TD WIDTH=406 height="29"><P ALIGN=LEFT><FONT FACE="Verdana"><FONT SIZE=2><B>For customer
                            
                            service information and/or technical support please fill in the
                            
                            following form: </B></FONT></FONT> </P></TD>
                          <TD WIDTH=215 BGCOLOR="#c0c0c0"><P ALIGN=LEFT><A HREF="news.html"><SPAN STYLE="background: transparent"><B>Subscribe
                            
                            to our eNewsletter</B></SPAN></A></P></TD>
                        </TR>
                        <TR VALIGN=TOP>
                          <TD WIDTH=406 height="298"><P>           
                              <FONT FACE="Verda na"><FONT SIZE=2> <FONT COLOR = "RED">
                              <div id ="errormessage" style = "display:none;color = Red"  > Required information is missing, incomplete or not correctly entered. Please correct your entries and try again. </div>
                                </FONT> Required customer service
                                
                                information:</FONT></FONT>
                              </P>
                              <P><FONT FACE="Verdana"><FONT SIZE=2> <Font Color = "Red"> * </Font> <B>First name:</B><BR>
                                      <INPUT TYPE=TEXT NAME="FIRST NAME" Id = "FIRSTNAME" SIZE=50 maxlength = 100>
                                      <BR>
                                      <Font Color = "Red"> * </Font> <B>Last name:</B><BR>
                                      <INPUT TYPE=TEXT NAME="LAST NAME"  Id = "LASTNAME" SIZE=50 maxlength = 100>
                                      <BR>
                                      <B>Title:</B><BR>
                                      <INPUT TYPE=TEXT NAME="TITLE"  SIZE=50 maxlength = 100>
                                      <BR>
                                      <B>Department:</B><BR>
                                      <INPUT TYPE=TEXT NAME="DEPT" SIZE=50 maxlength = 100>
                                      <BR>
                                      <B>Company/Organization:</B><BR>
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                                      <B> <Font Color = "Red"> * </Font> Street Address: </B> <BR>
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                                      <INPUT TYPE=TEXT NAME="CITY" ID = "CITY" SIZE=50 maxlength = 100>
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                                      <Font Color = "Red"> * </Font> <B>State: &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Zip:</B><BR>
                                      <INPUT TYPE=TEXT NAME="STATE" ID = "STATE"  SIZE=2 maxlength = 100>
                                &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
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                                <BR>
                                <Font Color = "Red"> * </Font> <B>Country:</B><BR>
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                                <Font Color = "Red"> * </Font> <B>Fax Number:</B> (if none, type &quot;none&quot;) <BR>
                                <INPUT TYPE=TEXT NAME="FAX" ID = "FAX" SIZE=50 maxlength = 100>
                            </FONT></FONT></P></TD>
                          <TD WIDTH=215><P ALIGN=LEFT><FONT SIZE=1>ABTECH wishes to maintain a record of
                            
                            the individuals requesting customer service information. This
                            
                            record is for administrative purposes only. In the event of
                            
                            changes or additions to our customer service package, ABTECH
                            
                            will use this record to notify all requestors of changes or
                            
                            additions.</FONT> </P>
                              <P ALIGN=LEFT><FONT SIZE=1><STRONG>NOTE:</STRONG> It is
                                
                                essential that you provide a complete and accurate mailing
                                
                                address. The web-site version of our product catalogues do not
                                
                                contain all the necessary technical support information. The
                                
                                information package you receive contains details of product
                                
                                specifications and application notes essential to the successful
                                
                                use of our products. This information package and product
                                
                                catalog will be mailed to the address you provide on this page.</FONT></P>
                            <P ALIGN=LEFT><FONT SIZE=1><B>If you are having problems with
                              
                              this form:</B><BR>
                              Be sure that your browser can handle forms. If
                              
                              your browser cannot use this page, you may request customer
                              
                              service information by sending an e-mail to <A HREF="mailto:[email protected]">[email protected]</A> or traditional mail to:</FONT></P>
                            <P ALIGN=LEFT><FONT SIZE=1>Customer Service Department:<BR>
                              ABTECH
                              
                              Scientific, Inc.<BR>
                              800 East Leigh Street, Suite 52, Richmond,
                              
                              Virginia 23219. USA<BR>
                              Tel: +001 804 827 7029<BR>
                              Fax: +001 804
                              
                              783 7830</FONT></P>
                            <P ALIGN=LEFT><FONT FACE="Verdana"><FONT SIZE=1>Thank you.</FONT></FONT></P></TD>
                        </TR>
                      </TABLE>
                  </DL>
                  <FONT FACE="Verdana"><FONT SIZE=2>Please check the
                    
                    appropriate boxes:<BR>
                       
                                <TABLE WIDTH=606 BORDER=0 align="left" CELLPADDING=0 CELLSPACING=0>
                                  <COL WIDTH=212>
                                  <COL WIDTH=187>
                                  <COL WIDTH=221>
                                  <TR>
                                    <TD WIDTH=193><P align="left" class="style4">
                                        <INPUT TYPE=CHECKBOX NAME="APPLICATIONS" VALUE="Food">
                                    Food Industry</P></TD>
                                    <TD WIDTH=214><P align="left" class="style4">
                                        <INPUT TYPE=CHECKBOX NAME="APPLICATIONS" VALUE="EnvironDiagnostics">
                                    Environmental Diagnostics</P></TD>
                                    <TD WIDTH=213><P align="left" class="style4">
                                        <INPUT TYPE=CHECKBOX NAME="APPLICATIONS" VALUE="AgriVet">
                                    Agricultural/Veterinarian</P></TD>
                                  </TR>
                                  <TR>
                                    <TD WIDTH=193><P align="left" class="style4">
                                        <INPUT TYPE=CHECKBOX NAME="APPLICATIONS" VALUE="Immunochem">
                                    Immunochemistry</P></TD>
                                    <TD WIDTH=214><P align="left" class="style4">
                                        <INPUT TYPE=CHECKBOX NAME="APPLICATIONS" VALUE="Forensics">
                                    Forensics</P></TD>
                                    <TD WIDTH=213><P align="left" class="style4">
                                        <INPUT TYPE=CHECKBOX NAME="APPLICATIONS" VALUE="Microbiology">
                                    Microbiology</P></TD>
                                  </TR>
                                  <TR>
                                    <TD WIDTH=193><P align="left" class="style4">
                                        <INPUT TYPE=CHECKBOX NAME="APPLICATIONS" VALUE="BioanalyticalChem">
                                    Bioanalytical Chemistry</P></TD>
                                    <TD WIDTH=214><P align="left" class="style4">
                                        <INPUT TYPE=CHECKBOX NAME="APPLICATIONS" VALUE="BiomedDiagnostics">
                                    Biomedical Diagnostics</P></TD>
                                    <TD WIDTH=213><P align="left" class="style4">
                                        <INPUT TYPE=CHECKBOX NAME="APPLICATIONS" VALUE="Other">
                                    Other</P></TD>
                                  </TR>
                  </TABLE>
                            </DL>
                          </DL>
                        </DL>
                      </DL>
                    </DL>
                  </DL>
                  <P ALIGN=CENTER><BR>
                      <B><FONT SIZE=2><br>
                      <br>
                  Discipline:</FONT></B></P>
                  
                  <div align="left">
                    <TABLE BORDER=0 align="left" CELLPADDING=0 CELLSPACING=2>
                      <TR>
                        <TD><P align="left">
                            <INPUT TYPE=CHECKBOX NAME="DISCIPLINE" VALUE="Biosensors">
                          Biosensor Development</P></TD>
                        <TD><P align="left">
                            <INPUT TYPE=CHECKBOX NAME="DISCIPLINE" VALUE="ChemSensors">
                          Chemical Sensor Development</P></TD>
                        <TD><P align="left">
                            <INPUT TYPE=CHECKBOX NAME="DISCIPLINE" VALUE="Polymers">
                          Polymer Materials Characterization</P></TD>
                      </TR>
                      <TR>
                        <TD><P align="left">
                            <INPUT TYPE=CHECKBOX NAME="DISCIPLINE" VALUE="Electrochemistry">
                          Micro Electrochemistry</P></TD>
                        <TD><P align="left">
                            <INPUT TYPE=CHECKBOX NAME="DISCIPLINE" VALUE="HPLC/LCDetectors">
                          HPLC/LC Detection</P></TD>
                        <TD><P align="left">
                            <INPUT TYPE=CHECKBOX NAME="DISCIPLINE" VALUE="Conductimetry">
                          Conductimetry</P></TD>
                      </TR>
                                          </TABLE>
                  </div>
                  <P ALIGN=left><BR>
                      <BR>
                  </P>
                  <CENTER>
                    <TABLE WIDTH=49% BORDER=0 CELLPADDING=0 CELLSPACING=2 align="left">
                      <TR>
                        <TD WIDTH=100%><P align="left"><B>Please send me Product Literature on:</B></P>
                            <P align="left">
                              <INPUT TYPE=CHECKBOX NAME="LITERATURE" VALUE="EPSIS">
                              <FONT SIZE=2>EPSIS - Electroactive Polymer Sensor Interrogation System<BR>
                              <INPUT TYPE=CHECKBOX NAME="LITERATURE" VALUE="EPMES">
                                EPMEs - Electroactive Polymer Transducers <BR>
                                <INPUT TYPE=CHECKBOX NAME="LITERATURE" VALUE="IMES">
                                IMEs - Interdigitated Microsensor Electrodes<BR>
                                <INPUT TYPE=CHECKBOX NAME="LITERATURE" VALUE="IAME/IAIME">
                                IAMEs and IAIMEs - Independently Addressable Microband Electrodes<BR>
                                <INPUT TYPE=CHECKBOX NAME="LITERATURE" VALUE="ECCS">
                                ECCs - Electrochemical Cell-on-a-Chip<BR>
                                <INPUT TYPE=CHECKBOX NAME="LITERATURE" VALUE="MDEAS">
                                MDEAs - Microdisc Electrode Arrays<BR>
                                <INPUT TYPE=CHECKBOX NAME="LITERATURE" VALUE="Accessories">
                                Accessories Catalog - The Laboratory Products Group<BR>
                                <INPUT TYPE=CHECKBOX NAME="LITERATURE" VALUE="BioSenSys">
                                BioSenSys - Handheld Diagnostics Workstation<BR>
                                <BR>
                                <B>I have other questions/comments:</B> <BR>
                                <TEXTAREA NAME="COMMENTS" ></TEXTAREA>
                                <br>
                                <br>
                          </FONT> 
                              <input name="submit" type=submit onClick  = "javascript:return validatepage()" value="Submit Form">
                              <input name="RESET" type=RESET value="Clear Form">
                              <font size=2>and start again</font></P></TD>
                      </TR>
                    </TABLE>
                  </CENTER>
                  
                    <P>&nbsp;</P>
                  </DIV>
                </FORM>
              <br>            </TD>
          </TR>
        </TABLE></td>
      </tr>
      <TR VALIGN=TOP>
        <TD HEIGHT=75><P ALIGN=CENTER STYLE="margin-bottom: 0in"><FONT FACE="Verdana"><FONT SIZE=2><B>Related Links</B></FONT></FONT><BR>
          </P>
            <P ALIGN=CENTER STYLE="margin-bottom: 0in"><FONT COLOR="#800000"><FONT SIZE=1 STYLE="font-size: 8pt">HEADQUARTERS:</FONT></FONT></P>
          <P ALIGN=CENTER STYLE="margin-bottom: 0in"><FONT COLOR="#800000"><FONT SIZE=1 STYLE="font-size: 8pt">ABTECH
            
            Scientific, Inc. </FONT></FONT> </P>
          <P ALIGN=CENTER STYLE="margin-bottom: 0in"><FONT SIZE=1 STYLE="font-size: 8pt"><FONT FACE="Wingdings"><FONT COLOR="#800000">n</FONT></FONT></FONT> <FONT SIZE=1 STYLE="font-size: 8pt">800 East Leigh Street <FONT FACE="Wingdings"><FONT COLOR="#800000">n</FONT></FONT></FONT> <FONT SIZE=1 STYLE="font-size: 8pt">Center Building, BioTech
            
            Research Park <FONT FACE="Wingdings"><FONT COLOR="#800000">n</FONT></FONT></FONT> <FONT SIZE=1 STYLE="font-size: 8pt">Richmond <FONT FACE="Wingdings"><FONT COLOR="#800000">n</FONT></FONT> Virginia 23219-1535 <FONT FACE="Wingdings"><FONT COLOR="#800000">n</FONT></FONT> USA</FONT></P>
          <P ALIGN=CENTER STYLE="margin-bottom: 0in"><FONT SIZE=1 STYLE="font-size: 8pt"><FONT FACE="Wingdings"><FONT COLOR="#008080">n</FONT></FONT></FONT> <FONT SIZE=1 STYLE="font-size: 8pt"><FONT FACE="Verdana, sans-serif">[email protected] </FONT><FONT FACE="Wingdings"><FONT COLOR="#008080">n</FONT></FONT></FONT></P>
          <P ALIGN=CENTER><FONT FACE="Verdana, sans-ser"><FONT SIZE=1 STYLE="font-size: 8pt">Tel.:
            
            +1 804 783 7829<BR>
            Fax.: +1 804 783 7830</FONT></FONT></P></TD>
      </TR>
      <TR>
        <TD HEIGHT=75 VALIGN=TOP><P ALIGN=CENTER STYLE="margin-bottom: 0in"><BR>
          </P>
            <P ALIGN=CENTER STYLE="margin-bottom: 0in"><FONT COLOR="#800000"><FONT SIZE=1 STYLE="font-size: 8pt">RESEARCH
              
              AND OPERATIONS:</FONT></FONT></P>
          <P ALIGN=CENTER STYLE="margin-bottom: 0in"><FONT COLOR="#800000"><FONT SIZE=1 STYLE="font-size: 8pt">ABTECH
            
            Scientific, Inc. </FONT></FONT> </P>
          <P ALIGN=CENTER STYLE="margin-bottom: 0in"><FONT SIZE=1 STYLE="font-size: 8pt"><FONT FACE="Wingdings"><FONT COLOR="#800000">n</FONT></FONT> Suite D-317 <FONT FACE="Wingdings"><FONT COLOR="#800000">n</FONT></FONT> 713 East Greenville Street <FONT FACE="Wingdings"><FONT COLOR="#800000">n</FONT></FONT> Anderson <FONT FACE="Wingdings"><FONT COLOR="#800000">n</FONT></FONT> South Carolina 29621 <FONT FACE="Wingdings"><FONT COLOR="#800000">n</FONT></FONT> USA</FONT></P>
          <P ALIGN=CENTER STYLE="margin-bottom: 0in"><FONT SIZE=1 STYLE="font-size: 8pt"><FONT FACE="Wingdings"><FONT COLOR="#008080">n</FONT></FONT></FONT> <FONT SIZE=1 STYLE="font-size: 8pt"><FONT FACE="Verdana, sans-serif">[email protected] </FONT><FONT FACE="Wingdings"><FONT COLOR="#008080">n</FONT></FONT></FONT></P>
          <P ALIGN=CENTER STYLE="margin-bottom: 0in"><FONT FACE="Verdana, sans-serif"><FONT SIZE=1 STYLE="font-size: 8pt">Tel.:
            
            +1 864 224 6047<BR>
            Fax.: +1 864 225 4761</FONT></FONT></P>
          <P ALIGN=CENTER><BR>
          </P></TD>
      </TR>
      <TR>
        <TD HEIGHT=37 VALIGN=TOP><P><A HREF="..\www.vabio.org\index.html"><FONT SIZE=1 STYLE="font-size: 8pt">Virginia
          
          Biotechnology Association</FONT></A></P></TD>
      </TR>
      <TR>
        <TD HEIGHT=37 VALIGN=TOP><P><A HREF="..\www.bio.org\index.html"><FONT SIZE=1 STYLE="font-size: 8pt">BIO
          
          - The Biotechnology Industry Organization</FONT></A> </P></TD>
      </TR>
      <TR>
        <TD HEIGHT=37 VALIGN=TOP><P><A HREF="..\www.mosis.org\index.html"><FONT SIZE=1 STYLE="font-size: 8pt">The
          
          MOSIS Service</FONT></A><FONT SIZE=1 STYLE="font-size: 8pt">:<BR>
            For
            
            custom production of CMOS devices</FONT></P></TD>
      </TR>
    </table>
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