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<html> <head> <meta http-equiv="content-type" content="text/html;charset=iso-8859-1"> <title>"Order Form"</title> <meta name="keywords" content="Order Form"> <meta name="keywords" content="Homeschool, Drama, Theater"> </head> <body text="#0033ff" link="#990033" background="BkgndY.jpg"> <form name="OrderForm" action="mailto:http://cgibin.rcn.com/familyplayhouse2/cgi-bin/mail_form.cgi" method="post" enctype="text/plain"></form> <table width="611" border="1" cellspacing="2" cellpadding="0"> <tr> <th align="center"> <div align="center"> <font size="4"><b>Order form for Drama Materials</b></font></div> </th> </tr> <tr> <td><input type="text" name="First Name" size="25" value="First Name" tabindex="1" id="ID_First Name_B473DF99"><input type="text" value="Last Name" name="Last Name" tabindex="2" size="30" id="ID_Last Name_B473DF99"></td> </tr> <tr> <td><input type="text" value="Street Address" name="Address" size="46" tabindex="3" id="ID_Street Address_B473DF99"></td> </tr> <tr> <td><input type="text" value="City" name="City" size="46" tabindex="4" id="ID_City_B473DF99"><input type="text" value="State" name="State" size="6" tabindex="5" id="ID_State_B473DF99"><input type="text" value="Zip" name="Zip" size="10" tabindex="6" id="ID_Zip_B473DF99"></td> </tr> <tr> <td><input type="text" value="Home Phone" name="Phone" size="15" tabindex="7" id="ID_Home Phone_B473DF99"><input type="text" value="Work Phone" name="Work Phone" size="15" tabindex="8" id="ID_Work Phone_B473DF99"><input type="text" value="Fax" name="Fax Phone" size="15" tabindex="9" id="ID_Fax_B473DF99"><input type="text" value="email address" name="Email" size="38" tabindex="10" id="ID_email address_B473DF99"></td> </tr> <tr> <td>We accept the following payment methods: Credit Cards (MasterCard, Visa or American Express) PayPal, Billpoint or personal check/money order. <p>We will respond shortly with order confirmation and payment options.</p> </td> </tr> <tr> <td> <table width="453" border="0" cellpadding="2"> <tr> <td width="23"><input type="radio" name="Product" value="Teaching Curriculum" border="0"></td> <td width="124">Teaching Curriculum</td> <td><input type="radio" name="Book Only" value="Book Only" border="0"></td> <td width="67">Book Only</td> <td width="23"><input type="radio" name="CD Only" value="CD Only" border="0"></td> <td>CD Only</td> <td width="21"><input type="radio" name="Book&CD" value="Book&CD" border="0"></td> <td>Book and CD</td> </tr> <tr> <td width="23"><input type="radio" name="Product" value="Saint Bernadette" border="0"></td> <td width="124">Saint Bernadette</td> <td><input type="radio" name="Book Only" value="Book Only" border="0"></td> <td width="67">Book Only</td> <td width="23"><input type="radio" name="CD Only" value="CD Only" border="0"></td> <td>CD Only</td> <td width="21"><input type="radio" name="Book&CD" value="Book&CD" border="0"></td> <td>Book and CD</td> </tr> <tr> <td width="23"><input type="radio" name="Product" value="Christmas Plays" border="0"></td> <td width="124">Christmas Plays</td> <td><input type="radio" name="Book Only" value="Book Only" border="0"></td> <td width="67">Book Only</td> <td width="23"><input type="radio" name="CD Only" value="CD Only" border="0"></td> <td>CD Only</td> <td width="21"><input type="radio" name="Book&CD" value="Book&CD" border="0"></td> <td>Book and CD</td> </tr> <tr> <td width="23"><input type="radio" name="Product" value="Teaching Curriculum" border="0"></td> <td width="124"></td> <td><input type="radio" name="Book Only" value="Book Only" border="0"></td> <td width="67">Book Only</td> <td width="23"><input type="radio" name="CD Only" value="CD Only" border="0"></td> <td>CD Only</td> <td width="21"><input type="radio" name="Book&CD" value="Book&CD" border="0"></td> <td>Book and CD</td> </tr> <tr> <td width="23"><input type="radio" name="Product" value="Teaching Curriculum" border="0"></td> <td width="124"></td> <td><input type="radio" name="Book Only" value="Book Only" border="0"></td> <td width="67">Book Only</td> <td width="23"><input type="radio" name="CD Only" value="CD Only" border="0"></td> <td>CD Only</td> <td width="21"><input type="radio" name="Book&CD" value="Book&CD" border="0"></td> <td>Book and CD</td> </tr> <tr> <td width="23"><input type="radio" name="Product" value="Teaching Curriculum" border="0"></td> <td width="124"></td> <td><input type="radio" name="Book Only" value="Book Only" border="0"></td> <td width="67">Book Only</td> <td width="23"><input type="radio" name="CD Only" value="CD Only" border="0"></td> <td>CD Only</td> <td width="21"><input type="radio" name="Book&CD" value="Book&CD" border="0"></td> <td>Book and CD</td> </tr> </table> <table width="158" border="0" cellspacing="2" cellpadding="2"> <tr> <td><csobj w="38" h="16" t="DateTime" format="ShortDate" region="0">5/24/02</csobj></td> <td><csobj w="49" h="16" t="DateTime" format="ShortTime" region="0">10:35 PM</csobj></td> </tr> </table> </td> </tr> <tr> <td> <div align="center"> <input type="submit" value="Click here to order" name="SUBMIT VALUE"> <form action="(EmptyReference!)" method="get" name="FormName"> </form> </form></div> </td> </tr> <tr> <td> <div align="center"> <a href="index.html">Home</a></div> </td> </tr> </table> </body> </html>