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<html>
<!-------------------------------------------------------
COMPANY: VIATEQ CORPORATION
AUTHOR: Dennis Dunston
DATE: October 2016
DESCRIPTION: Form translation.
-------------------------------------------------------->
<HEAD>
<meta content="text/html; charset=ISO-8859-1" http-equiv="content-type">
<meta name="description" content="VIATEQ CORPORATION">
<meta name="keywords" content="VIATEQ CORPORATION">
<!-------------------------------------------------------
STYLE GUIDE
-------------------------------------------------------->
<script language="javascript" type="text/javascript" src="datetimepicker.js">
</script>
<style>
body {background-color: white;}
h1 {
color: black;
font-family: Calibri, Candara, Segoe, "Segoe UI", Optima, Arial, sans-serif;
font-size: 14px;
font-style: normal;
font-variant: normal;
font-weight: 500;
line-height: 15px;
}
h2 {
color: black;
font-family: Calibri, Candara, Segoe, "Segoe UI", Optima, Arial, sans-serif;
font-size: 22px;
font-style: normal;
font-variant: normal;
font-weight: 500;
line-height: 20px;
}
h3 {
color: black;
font-family: Calibri, Candara, Segoe, "Segoe UI", Optima, Arial, sans-serif;
font-size: 10px;
font-style: normal;
font-variant: normal;
font-weight: 500;
line-height: 9px;
}
input {
border: 0;
outline: 0;
background: transparent;
border-bottom: 1px solid black;
}
textarea {
border: 0;
outline: 0;
background: transparent;
border-bottom: 1px solid black;
}
</style>
</HEAD>
<TITLE>Form Translation</TITLE>
<body>
<!-------------------------------------------------------
STYLE GUIDE
-------------------------------------------------------->
<script>
function validateForm() {
alert('Call validateForm');
}
function clear_form() {
alert("Call clear");
}
function print_form() {
alert("Call Print");
}
</script>
<!-------------------------------------------------------
-------------------------------------------------------->
<form action="http://www.conceptlabs.com/viateq/demo/viateq.asp" method="POST">
<!------------------------
Outer Table
------------------------->
<table bgcolor="white" width="800px" border="0" cellspacing="0" cellpadding="0" align="center" cols=1>
<!------------------------
------------------------->
<tr>
<td valign="top">
<br>
<br>
<h1>
<button onclick="validateForm()">Submit Form</button>
<button onclick="clear_form()">Reset Form</button>
<button onclick="print_form()">Print Form</button>
</h1>
<!-------------------------------------------------------
-------------------------------------------------------->
<div align="center">
<!------------------------
FORM
------------------------->
<table width="800px" border="1" cellspacing="0" cellpadding="10" align="center" cols=2>
<tbody>
<!------------------------
FIRST ROW
------------------------->
<tr>
<td width="20%" align=left>
<h1>
<b>How can we<br>reach you?</b>
</h1>
</td>
<td align=left>
<h1>
Name (First, Middle, Last):
<input size= "50" type="text" name="Fullname1">
<br>
Print Signature textfield:
<textarea rows="5" name="Print_Signature" cols="60"></textarea>
<br>
Date: <input type="Text" id="demo1" maxlength="25" size="25" name="Print_Signature_Date">
<a href="javascript:NewCal('demo1','ddmmmyyyy',true,24)">
<img src="http://www.conceptlabs.com/viateq/demo/cal.gif" width="16" height="16" border="0" alt="Pick a date">
</a>
Date: <input type="date" id="demo1" maxlength="25" size="25" name="Print_Signature_Date">
</h1>
</td>
</tr>
</tbody>
</table>
</div>
<div align="right">
<h1>
Form CC-4 (revised 01/20XX)
</h1>
</div>
</td>
</tr>
</table>
</form>
</body>
</html>