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<title>New Page 2</title>
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<h1 align="center"><img border="0" src="tmcs.h1.jpg" width="196" height="143">
Order
Form <img border="0" src="tmcs.h2.gif" width="158" height="117"></h1>
<hr align="center">
<p align="center"><font color="#0000FF"><b>Online ordering form for ordering
parts and starters. </b></font> </p>
<form METHOD="POST" action="_derived/nortbots.htm" onSubmit="location.href='_derived/nortbots.htm';return false;" webbot-action="--WEBBOT-SELF--" WEBBOT-onSubmit>
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<p> </p>
<p>Please provide the following contact information: </p>
<p align="center"><font color="#FF0000" size="5"><b><blink>WE ARE NOT YET
TAKING ORDERS ON LINE.</blink></b></font></p>
<p align="center"><font color="#FF0000" size="5"><b><blink>PLEASE CALL THE
SHOP FOR ORDERS AND BIDS.</blink></b></font></p>
<p align="center"><font color="#FF0000" size="5"><b><blink>301-590-3005</blink></b></font></p>
<blockquote>
<table>
<tr>
<td ALIGN="right"><em>First
Name</em></td>
<td><input TYPE="TEXT" NAME="Contact_FirstName" SIZE="25"></td>
</tr>
<tr>
<td ALIGN="right"><em>Last
Name</em></td>
<td><input TYPE="TEXT" NAME="Contact_LastName" SIZE="25"></td>
</tr>
<tr>
<td ALIGN="right"><em>Organization</em></td>
<td><input TYPE="TEXT" NAME="Contact_Organization" SIZE="35"></td>
</tr>
<tr>
<td ALIGN="right"><em>Street
Address</em></td>
<td><input TYPE="TEXT" NAME="Contact_StreetAddress" SIZE="35"></td>
</tr>
<tr>
<td ALIGN="right"><em>Address
(cont.)</em></td>
<td><input TYPE="TEXT" NAME="Contact_Address2" SIZE="35"></td>
</tr>
<tr>
<td ALIGN="right"><em>City</em></td>
<td><input TYPE="TEXT" NAME="Contact_City" SIZE="35"></td>
</tr>
<tr>
<td ALIGN="right"><em>State/Province</em></td>
<td><input TYPE="TEXT" NAME="Contact_State" SIZE="35"></td>
</tr>
<tr>
<td ALIGN="right"><em>Zip/Postal
Code</em></td>
<td><input TYPE="TEXT" NAME="Contact_ZipCode" SIZE="12" MAXLENGTH="12"></td>
</tr>
<tr>
<td ALIGN="right"><em>Work
Phone</em></td>
<td><input TYPE="TEXT" NAME="Contact_WorkPhone" SIZE="25" MAXLENGTH="25"></td>
</tr>
<tr>
<td ALIGN="right"><em>FAX</em></td>
<td><input TYPE="TEXT" NAME="Contact_FAX" SIZE="25" MAXLENGTH="25"></td>
</tr>
<tr>
<td ALIGN="right"><em>E-mail</em></td>
<td><input TYPE="TEXT" NAME="Contact_Email" SIZE="25"></td>
</tr>
</table>
</blockquote>
<p align="center"><font color="#0000FF"><b>Please provide the following
ordering information: When ordering starters, remember (check the FAQ section)
</b></font></p>
<p align="center"><font color="#0000FF"><b>Horsepower, Primary Voltage,
control voltage and accessories. If you do not know the catalog number
of the item you are ordering, provide as much detail as possible and a technician
will call back and discuss your needs.</b></font></p>
<p align="center"><b><font color="#FF0000">Please indicate if this is a
request for a quote only. Write "quote only" in the first item
description column.</font><font color="#0000FF"> </font></b></p>
<p align="center"> </p>
<blockquote>
<table>
<tr>
<td>
<p align="center"><strong>QTY</strong></p>
</td>
<td>
<p align="center"><strong>DESCRIPTION</strong></p>
</td>
</tr>
<tr>
<td><input TYPE="TEXT" NAME="Ordering_OrderQty0" SIZE="6" MAXLENGTH="6"></td>
<td><input NAME="Ordering_OrderDesc0" SIZE="80"></td>
</tr>
<tr>
<td><input TYPE="TEXT" NAME="Ordering_OrderQty1" SIZE="6" MAXLENGTH="6"></td>
<td><input NAME="Ordering_OrderDesc15" SIZE="80"></td>
</tr>
<tr>
<td><input TYPE="TEXT" NAME="Ordering_OrderQty2" SIZE="6" MAXLENGTH="6"></td>
<td><input NAME="Ordering_OrderDesc16" SIZE="80"></td>
</tr>
<tr>
<td><input TYPE="TEXT" NAME="Ordering_OrderQty3" SIZE="6" MAXLENGTH="6"></td>
<td><input NAME="Ordering_OrderDesc17" SIZE="80"></td>
</tr>
<tr>
<td><input TYPE="TEXT" NAME="Ordering_OrderQty4" SIZE="6" MAXLENGTH="6"></td>
<td><input NAME="Ordering_OrderDesc18" SIZE="80"></td>
</tr>
<tr>
<td><input TYPE="TEXT" NAME="Ordering_OrderQty5" SIZE="6" MAXLENGTH="6"></td>
<td><input NAME="Ordering_OrderDesc19" SIZE="80"></td>
</tr>
<tr>
<td><input TYPE="TEXT" NAME="Ordering_OrderQty6" SIZE="6" MAXLENGTH="6"></td>
<td><input NAME="Ordering_OrderDesc20" SIZE="80"></td>
</tr>
<tr>
<td><input TYPE="TEXT" NAME="Ordering_OrderQty7" SIZE="6" MAXLENGTH="6"></td>
<td><input NAME="Ordering_OrderDesc21" SIZE="80"></td>
</tr>
<tr>
<td><input TYPE="TEXT" NAME="Ordering_OrderQty8" SIZE="6" MAXLENGTH="6"></td>
<td><input NAME="Ordering_OrderDesc22" SIZE="80"></td>
</tr>
<tr>
<td><input TYPE="TEXT" NAME="Ordering_OrderQty9" SIZE="6" MAXLENGTH="6"></td>
<td><input NAME="Ordering_OrderDesc23" SIZE="80"></td>
</tr>
<tr>
<td><input TYPE="TEXT" NAME="Ordering_OrderQty10" SIZE="6" MAXLENGTH="6"></td>
<td><input NAME="Ordering_OrderDesc24" SIZE="80"></td>
</tr>
<tr>
<td><input TYPE="TEXT" NAME="Ordering_OrderQty11" SIZE="6" MAXLENGTH="6"></td>
<td><input NAME="Ordering_OrderDesc25" SIZE="80"></td>
</tr>
<tr>
<td><input TYPE="TEXT" NAME="Ordering_OrderQty12" SIZE="6" MAXLENGTH="6"></td>
<td><input NAME="Ordering_OrderDesc26" SIZE="80"></td>
</tr>
<tr>
<td><input TYPE="TEXT" NAME="Ordering_OrderQty13" SIZE="6" MAXLENGTH="6"></td>
<td><input NAME="Ordering_OrderDesc27" SIZE="80"></td>
</tr>
<tr>
<td><input TYPE="TEXT" NAME="Ordering_OrderQty14" SIZE="6" MAXLENGTH="6"></td>
<td><input NAME="Ordering_OrderDesc28" SIZE="80"></td>
</tr>
</table>
<p> </p>
<table>
<tr>
<td></td>
<td>
<p align="center"><strong>BILLING</strong></p>
</td>
</tr>
<tr>
<td ALIGN="right"><em>Purchase
Order #</em></td>
<td><input TYPE="TEXT" NAME="Ordering_PONumber" SIZE="25"></td>
</tr>
<tr>
<td ALIGN="right"><em>Account
Name</em></td>
<td><input TYPE="TEXT" NAME="Ordering_POAccount" SIZE="25"></td>
</tr>
</table>
<p> </p>
<table>
<tr>
<td></td>
<td>
<p align="center"><strong>SHIPPING</strong></p>
</td>
</tr>
<tr>
<td ALIGN="right">Attention:</td>
<td><input TYPE="TEXT" NAME="Ordering_StreetAddress1" SIZE="35"></td>
</tr>
<tr>
<td ALIGN="right"><em>Street
Address</em></td>
<td><input TYPE="TEXT" NAME="Ordering_StreetAddress" SIZE="35"></td>
</tr>
<tr>
<td ALIGN="right"><em>Address
(cont.)</em></td>
<td><input TYPE="TEXT" NAME="Ordering_Address2" SIZE="35"></td>
</tr>
<tr>
<td ALIGN="right"><em>City</em></td>
<td><input TYPE="TEXT" NAME="Ordering_City" SIZE="35"></td>
</tr>
<tr>
<td ALIGN="right"><em>State/Province</em></td>
<td><input TYPE="TEXT" NAME="Ordering_State" SIZE="35"></td>
</tr>
<tr>
<td ALIGN="right"><em>Zip/Postal
Code</em></td>
<td><input TYPE="TEXT" NAME="Ordering_ZipCode" SIZE="12" MAXLENGTH="12"></td>
</tr>
</table>
</blockquote>
<a href="index.htm"><input TYPE="submit" VALUE="Submit Form"></a> <input TYPE="RESET" VALUE="Reset Form">
<b><font color="#FF0000">If the form does not send properly, print out the
form and fax it. 301-590-3006</font></b>
</form>
<hr align="center">
<h5><a href="mailto:[email protected]">[email protected]</a>
</h5>
<h5>Copyright
� 2003 <font color="#0000FF"><b> EMSCO, The Motor Control Shop</b></font>. All
rights reserved.<br>
Revised: <!--webbot bot="TimeStamp" S-Type="EDITED"
S-Format="%B %d, %Y" startspan -->November 29, 2003<!--webbot bot="TimeStamp" endspan i-checksum="39607" --></h5>
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