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<html> <head> <meta http-equiv="content-type" content="text/html;charset=iso-8859-1"> <title>"Order Form"</title> <meta name="generator" content="Order Form"> </head> <body text="#0033ff" link="#990033" background="BkgndY.jpg"> <csobj w="36" h="12" t="DateTime" format="ShortDate" region="0">1/25/00</csobj> at <csobj w="42" h="12" t="DateTime" format="ShortTime" region="0">1:16 PM</csobj> <table cool width="785" height="1068" border="0" cellpadding="0" cellspacing="0" gridx="16" showgridx usegridx gridy="16" showgridy usegridy> <tr height="1" cntrlrow> <td width="1" height="1"></td> <td width="16" height="1"><spacer type="block" width="16" height="1"></td> <td width="16" height="1"><spacer type="block" width="16" height="1"></td> <td width="113" height="1"><spacer type="block" width="113" height="1"></td> <td width="48" height="1"><spacer type="block" width="48" height="1"></td> <td width="16" height="1"><spacer type="block" width="16" height="1"></td> <td width="64" height="1"><spacer 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height="1"></td> <td width="352" height="1"><spacer type="block" width="352" height="1"></td> </tr> <tr height="16"> <td width="1" height="16"><spacer type="block" width="1" height="16"></td> <td width="16" height="16"></td> <td width="16" height="16"></td> <td width="113" height="16"></td> <td width="48" height="16"></td> <td width="591" height="48" colspan="16" rowspan="2" valign="top" align="left" xpos="193"> <table border="4" cellpadding="0" cellspacing="2" width="400"> <tr> <td> <center> <font size="4"><b>Order form for Drama Materials</b></font></center> </td> </tr> </table> </td> </tr> <tr height="32"> <td width="1" height="32"><spacer type="block" width="1" height="32"></td> <td width="16" height="32" colspan="1" rowspan="1" valign="top" align="left" xpos="0"> <form name="OrderForm" action="https://secure.authorize.net/gateway/transact.ddl" method="post"> </td> <td width="16" height="32"></td> <td width="113" height="32"></td> <td width="48" height="32"></td> </tr> <tr height="55"> <td width="1" height="55"><spacer type="block" width="1" height="55"></td> <td width="16" height="55"></td> <td width="16" height="55"></td> <td width="113" height="55"></td> <td width="48" height="55"></td> <td width="16" height="55"></td> <td width="64" height="55"></td> <td width="31" height="55"></td> <td width="16" height="55" colspan="1" rowspan="1" valign="top" align="left" xpos="304"><input type="hidden" value="PAYMENT_FORM" name="x_Show_Form"></td> <td width="16" height="55" colspan="2" rowspan="1" valign="top" align="left" xpos="320"><input type="hidden" value="3.0" name="x_Version"></td> <td width="16" height="55" colspan="1" rowspan="1" valign="top" align="left" xpos="336"><input type="hidden" value="playhouse" name="x_login"></td> <td width="16" height="55" colspan="2" rowspan="1" valign="top" align="left" xpos="352"><input type="hidden" value="deslie" name="x_password"></td> <td width="16" height="55" colspan="1" rowspan="1" valign="top" align="left" xpos="368"><input type="hidden" value="http://www.familyplayhouse.com/LogoMask.gif" name="x_Logo_URL"></td> <td width="16" height="55" colspan="2" rowspan="1" valign="top" align="left" xpos="384"><input type="hidden" value="TRUE" name="x_Email_Customer"></td> <td width="16" height="55" colspan="2" rowspan="1" valign="top" align="left" xpos="400"><input type="hidden" value="amount goes here" name="x_Amount"></td> <td width="16" height="55" colspan="1" rowspan="1" valign="top" align="left" xpos="416"><input type="hidden" value="CC" name="x_Method"></td> <td width="352" height="55" colspan="1" rowspan="1" valign="top" align="left" xpos="432"><input type="hidden" value="TRUE" name="x_VT"></td> </tr> <tr height="32"> <td width="1" height="32"><spacer type="block" width="1" height="32"></td> <td width="16" height="32"></td> <td width="177" height="32" colspan="3" rowspan="1" valign="top" align="left" xpos="16"><input type="text" name="x_First_Name" size="25" value="First Name" tabindex="1" id="ID_First Name_B473DF99"></td> <td width="16" height="32"></td> <td width="192" height="32" colspan="12" rowspan="1" valign="top" align="left" xpos="209"><input type="text" value="Last Name" name="x_Last_Name" tabindex="2" size="30" id="ID_Last Name_B473DF99"></td> <td width="15" height="32"></td> <td width="16" height="32"></td> <td width="352" height="32"></td> </tr> <tr height="32"> <td width="1" height="32"><spacer type="block" width="1" height="32"></td> <td width="16" height="32"></td> <td width="288" height="32" colspan="6" rowspan="1" valign="top" align="left" xpos="16"><input type="text" value="Street Address" name="x_Address" size="46" tabindex="3" id="ID_Street Address_B473DF99"></td> <td width="16" height="32"></td> <td width="1" height="32"></td> <td width="15" height="32"></td> <td width="16" height="32"></td> <td width="1" height="32"></td> <td width="15" height="32"></td> <td width="16" height="32"></td> <td width="1" height="32"></td> <td width="15" height="32"></td> <td width="1" height="32"></td> <td width="15" height="32"></td> <td width="16" height="32"></td> <td width="352" height="32"></td> </tr> <tr height="32"> <td width="1" height="32"><spacer type="block" width="1" height="32"></td> <td width="16" height="32"></td> <td width="288" height="32" colspan="6" rowspan="1" valign="top" align="left" xpos="16"><input type="text" value="City" name="x_City" size="46" tabindex="4" id="ID_City_B473DF99"></td> <td width="16" height="32"></td> <td width="1" height="32"></td> <td width="63" height="32" colspan="5" rowspan="1" valign="top" align="left" xpos="321"><input type="text" value="State" name="x_State" size="6" tabindex="5" id="ID_State_B473DF99"></td> <td width="1" height="32"></td> <td width="399" height="32" colspan="5" rowspan="1" valign="top" align="left" xpos="385"><input type="text" value="Zip" name="x_Zip" size="10" tabindex="6" id="ID_Zip_B473DF99"></td> </tr> <tr height="41"> <td width="1" height="41"><spacer type="block" width="1" height="41"></td> <td width="16" height="41"></td> <td width="129" height="41" colspan="2" rowspan="1" valign="top" align="left" xpos="16"><input type="text" value="Home Phone" name="x_Phone" size="15" tabindex="7" id="ID_Home Phone_B473DF99"></td> <td width="128" height="41" colspan="3" rowspan="1" valign="top" align="left" xpos="145"><input type="text" value="Work Phone" name="x_Phone" size="15" tabindex="8" id="ID_Work Phone_B473DF99"></td> <td width="111" height="41" colspan="8" rowspan="1" valign="top" align="left" xpos="273"><input type="text" value="Fax" name="x_Phone" size="15" tabindex="9" id="ID_Fax_B473DF99"></td> <td width="1" height="41"></td> <td width="15" height="41"></td> <td width="1" height="41"></td> <td width="383" height="41" colspan="3" rowspan="1" valign="top" align="left" xpos="401"><input type="text" value="email address" name="x_Email" size="38" tabindex="10" id="ID_email address_B473DF99"></td> </tr> <tr height="39"> <td width="1" height="39"><spacer type="block" width="1" height="39"></td> <td width="16" height="39"></td> <td width="177" height="39" colspan="3" rowspan="1" valign="top" align="left" xpos="16"><input type="text" name="x_Card_Num" size="24"></td> <td width="16" height="39"></td> <td width="64" height="39"></td> <td width="31" height="39"></td> <td width="16" height="39"></td> <td width="1" height="39"></td> <td width="15" height="39"></td> <td width="16" height="39"></td> <td width="1" height="39"></td> <td width="15" height="39"></td> <td width="16" height="39"></td> <td width="1" height="39"></td> <td width="15" height="39"></td> <td width="1" height="39"></td> <td width="15" height="39"></td> <td width="16" height="39"></td> <td width="352" height="39"></td> </tr> <tr height="32"> <td width="1" height="32"><spacer type="block" width="1" height="32"></td> <td width="16" height="32"></td> <td width="257" height="96" colspan="5" rowspan="3" valign="top" align="left" xpos="16"><select name="selectName" size="6" multiple> <option value="$144.00" selected>3-8 age group CD for $144.00 <option value="$182.00">8-12 age group CD for $182.00 <option value="$285.00">Teen/Adult CD for $285.00 <option value="$185.00">Patriotic CD for $185.00 <option value="$95.00">Shakespeare CD for $95.00 <option value="$185.00">Christmas CD for $185.00 </select></td> <td width="31" height="32"></td> <td width="480" height="32" colspan="13" rowspan="1" valign="top" align="left" xpos="304"><input type="text" value="Please enter total order amount here" name="Total Order Amount" size="44" tabindex="14"></td> </tr> <tr height="32"> <td width="1" height="32"><spacer type="block" width="1" height="32"></td> <td width="16" height="32"></td> <td width="31" height="32"></td> <td width="480" height="32" colspan="13" rowspan="1" valign="top" align="left" xpos="304"><input type="text" value="Please add $5 for shipping/handling" name="Shipping" size="35" tabindex="15"></td> </tr> <tr height="32"> <td width="1" height="32"><spacer type="block" width="1" height="32"></td> <td width="16" height="32"></td> <td width="31" height="32"></td> <td width="480" height="32" colspan="13" rowspan="1" valign="top" align="left" xpos="304"><input type="text" value="Please add 6% sales tax if PA resident" name="Sales Tax" tabindex="16" size="40"></td> </tr> <tr height="9"> <td width="1" height="9"><spacer type="block" width="1" height="9"></td> <td width="16" height="9"></td> <td width="16" height="9"></td> <td width="113" height="9"></td> <td width="48" height="9"></td> <td width="16" height="9"></td> <td width="64" height="9"></td> <td width="31" height="9"></td> <td width="112" height="41" colspan="11" rowspan="2" valign="top" align="left" xpos="304"><input type="text" value="Total Amount $" name="x_Amount" size="15" tabindex="17"></td> <td width="16" height="9"></td> <td width="352" height="9"></td> </tr> <tr height="32"> <td width="1" height="32"><spacer type="block" width="1" height="32"></td> <td width="16" height="32"></td> <td width="16" height="32"></td> <td width="241" height="32" colspan="4" rowspan="1" valign="top" align="left" xpos="32"><input type="submit" value="Click here for secure payment form" name="SUBMIT VALUE"></td> <td width="31" height="32"></td> <td width="16" height="32"></td> <td width="352" height="32"></td> </tr> <tr height="59"> <td width="1" height="59"><spacer type="block" width="1" height="59"></td> <td width="16" height="59"></td> <td width="16" height="59"></td> <td width="113" height="59" colspan="1" rowspan="1" valign="top" align="left" xpos="32"> </form> </td> <td width="48" height="59"></td> <td width="16" height="59"></td> <td width="64" height="59"></td> <td width="31" height="59"></td> <td width="16" height="59"></td> <td width="1" height="59"></td> <td width="15" height="59"></td> <td width="16" height="59"></td> <td width="1" height="59"></td> <td width="15" height="59"></td> <td width="16" height="59"></td> <td width="1" height="59"></td> <td width="15" height="59"></td> <td width="1" height="59"></td> <td width="15" height="59"></td> <td width="16" height="59"></td> <td width="352" height="59"></td> </tr> <tr height="32"> <td width="1" height="32"><spacer type="block" width="1" height="32"></td> <td width="784" height="32" colspan="20" rowspan="1" valign="top" align="left" xpos="0" content csheight="32"> <center> <a href="index.html">Home</a></center> </td> </tr> <tr height="560"> <td width="1" height="560"><spacer type="block" width="1" height="560"></td> <td width="16" height="560"></td> <td width="16" height="560"></td> <td width="113" height="560"></td> <td width="48" height="560"></td> <td width="16" height="560"></td> <td width="64" height="560"></td> <td width="31" height="560"></td> <td width="16" height="560"></td> <td width="1" height="560"></td> <td width="15" height="560"></td> <td width="16" height="560"></td> <td width="1" height="560"></td> <td width="47" height="560" colspan="4" rowspan="1" valign="top" align="left" xpos="353"><img height="103" width="40" src="AngelUp.gif"></td> <td width="1" height="560"></td> <td width="15" height="560"></td> <td width="16" height="560"></td> <td width="352" height="560"></td> </tr> </table> </body> </html>