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<title>Order Form</title>
<meta name="Microsoft Theme" content="indust 111, default"><meta name="Microsoft Border" content="t"></head>
<body background="_themes/indust/indtextb.jpg" bgcolor="#FFFFFF" text="#000000" link="#3366CC" vlink="#666666" alink="#FF3300"><!--msnavigation--><table border="0" cellpadding="0" cellspacing="0" width="100%"><tr><td><!--mstheme--><font face="trebuchet ms, arial, helvetica">
<p align="center"><font size="6"><strong><img src="_derived/order.htm_cmp_indust110_bnr.gif" width="600" height="60" border="0" alt="Order Form"></strong></font></p>
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<!--mstheme--></font></td></tr><!--msnavigation--></table><!--msnavigation--><table border="0" cellpadding="0" cellspacing="0" width="100%"><tr><!--msnavigation--><td valign="top"><!--mstheme--><font face="trebuchet ms, arial, helvetica">
<h1><!--mstheme--><font color="#CC3300">Order Form<!--mstheme--></font></h1>
<!--msthemeseparator--><p align="center"><img src="_themes/indust/indhorsa.gif" width="300" height="10"></p>
<p>How may we help you?</p>
<form METHOD="POST" name="Schellin and Associates Order Form" action="_vti_bin/shtml.dll/order.htm" webbot-action="--WEBBOT-SELF--">
<!--webbot bot="SaveResults" U-File="formrslt.htm" S-Format="HTML/DL" S-Label-Fields="TRUE" B-Reverse-Chronology="FALSE" S-Email-Format="HTML/PRE" S-Email-Address="[email protected]" B-Email-Label-Fields="TRUE" S-Builtin-Fields="Date Time REMOTE_NAME REMOTE_USER HTTP_USER_AGENT" U-Confirmation-Url="dear.htm" startspan --><input TYPE="hidden" NAME="VTI-GROUP" VALUE="0"><!--webbot bot="SaveResults" endspan i-checksum="43374" --><p>* Please
provide the following contact information:</p>
<blockquote>
<!--mstheme--></font><table>
<tr>
<td ALIGN="right"><!--mstheme--><font face="trebuchet ms, arial, helvetica"><em>First name</em><!--mstheme--></font></td>
<td><!--mstheme--><font face="trebuchet ms, arial, helvetica"><input TYPE="TEXT" NAME="Contact_FirstName" SIZE="25"> *<!--mstheme--></font></td>
</tr>
<tr>
<td ALIGN="right"><!--mstheme--><font face="trebuchet ms, arial, helvetica"><em>Last name</em><!--mstheme--></font></td>
<td><!--mstheme--><font face="trebuchet ms, arial, helvetica"><input TYPE="TEXT" NAME="Contact_LastName" SIZE="25"> *<!--mstheme--></font></td>
</tr>
<tr>
<td ALIGN="right"><!--mstheme--><font face="trebuchet ms, arial, helvetica"><em>Middle initial</em><!--mstheme--></font></td>
<td><!--mstheme--><font face="trebuchet ms, arial, helvetica"><input TYPE="TEXT" NAME="Contact_MiddleInitial" SIZE="4" MAXLENGTH="1"> <!--mstheme--></font></td>
</tr>
<tr>
<td ALIGN="right"><!--mstheme--><font face="trebuchet ms, arial, helvetica"><em>Title</em><!--mstheme--></font></td>
<td><!--mstheme--><font face="trebuchet ms, arial, helvetica"><input TYPE="TEXT" NAME="Contact_Title" SIZE="35"> <!--mstheme--></font></td>
</tr>
<tr>
<td ALIGN="right"><!--mstheme--><font face="trebuchet ms, arial, helvetica"><em>Organization</em><!--mstheme--></font></td>
<td><!--mstheme--><font face="trebuchet ms, arial, helvetica"><input TYPE="TEXT" NAME="Contact_Organization" SIZE="35"> <!--mstheme--></font></td>
</tr>
<tr>
<td ALIGN="right"><!--mstheme--><font face="trebuchet ms, arial, helvetica"><em>Street address</em><!--mstheme--></font></td>
<td><!--mstheme--><font face="trebuchet ms, arial, helvetica"><input TYPE="TEXT" NAME="Contact_StreetAddress" SIZE="35"> <!--mstheme--></font></td>
</tr>
<tr>
<td ALIGN="right"><!--mstheme--><font face="trebuchet ms, arial, helvetica"><em>Address (cont.)</em><!--mstheme--></font></td>
<td><!--mstheme--><font face="trebuchet ms, arial, helvetica"><input TYPE="TEXT" NAME="Contact_Address2" SIZE="35"> <!--mstheme--></font></td>
</tr>
<tr>
<td ALIGN="right"><!--mstheme--><font face="trebuchet ms, arial, helvetica"><em>City</em><!--mstheme--></font></td>
<td><!--mstheme--><font face="trebuchet ms, arial, helvetica"><input TYPE="TEXT" NAME="Contact_City" SIZE="35"> <!--mstheme--></font></td>
</tr>
<tr>
<td ALIGN="right"><!--mstheme--><font face="trebuchet ms, arial, helvetica"><em>State/Province</em><!--mstheme--></font></td>
<td><!--mstheme--><font face="trebuchet ms, arial, helvetica"><input TYPE="TEXT" NAME="Contact_State" SIZE="35"> <!--mstheme--></font></td>
</tr>
<tr>
<td ALIGN="right"><!--mstheme--><font face="trebuchet ms, arial, helvetica"><em>Zip/Postal code</em><!--mstheme--></font></td>
<td><!--mstheme--><font face="trebuchet ms, arial, helvetica"><input TYPE="TEXT" NAME="Contact_ZipCode" SIZE="12" MAXLENGTH="12"> <!--mstheme--></font></td>
</tr>
<tr>
<td ALIGN="right"><!--mstheme--><font face="trebuchet ms, arial, helvetica"><em>Country</em><!--mstheme--></font></td>
<td><!--mstheme--><font face="trebuchet ms, arial, helvetica"><input TYPE="TEXT" NAME="Contact_Country" SIZE="25"> <!--mstheme--></font></td>
</tr>
<tr>
<td ALIGN="right"><!--mstheme--><font face="trebuchet ms, arial, helvetica"><em>Work Phone</em><!--mstheme--></font></td>
<td><!--mstheme--><font face="trebuchet ms, arial, helvetica"><input TYPE="TEXT" NAME="Contact_WorkPhone" SIZE="25" MAXLENGTH="25"> *<!--mstheme--></font></td>
</tr>
<tr>
<td ALIGN="right"><!--mstheme--><font face="trebuchet ms, arial, helvetica"><em>FAX</em><!--mstheme--></font></td>
<td><!--mstheme--><font face="trebuchet ms, arial, helvetica"><input TYPE="TEXT" NAME="Contact_FAX" SIZE="25" MAXLENGTH="25"> <!--mstheme--></font></td>
</tr>
<tr>
<td ALIGN="right"><!--mstheme--><font face="trebuchet ms, arial, helvetica"><em>E-mail</em><!--mstheme--></font></td>
<td><!--mstheme--><font face="trebuchet ms, arial, helvetica"><input TYPE="TEXT" NAME="Contact_Email" SIZE="25"> <!--mstheme--></font></td>
</tr>
<tr>
<td ALIGN="right"><!--mstheme--><font face="trebuchet ms, arial, helvetica"><em>URL</em><!--mstheme--></font></td>
<td><!--mstheme--><font face="trebuchet ms, arial, helvetica"><input TYPE="TEXT" NAME="Contact_URL" SIZE="25" MAXLENGTH="25"> <!--mstheme--></font></td>
</tr>
</table><!--mstheme--><font face="trebuchet ms, arial, helvetica">
</blockquote>
<p>Select any of the following options that apply:</p>
<blockquote>
<p><input TYPE="CHECKBOX" NAME="Option_patent copy" value="ON"> patent copy
<input TYPE="CHECKBOX" NAME="Option_file history" value="ON"> file
history <input TYPE="CHECKBOX" NAME="Option_cerification" value="ON">
cerification</p>
<p>Please enter your request below:</p>
<p><textarea rows="4" name="Request" cols="50"></textarea></p>
<p> </p>
<p>We will respond by:</p>
<p><input type="radio" value="Phone" checked name="Response">Phone <input type="radio" name="Response" value="Fax">Fax <input type="radio" name="Response" value="E-Mail">E-Mail <input type="radio" name="Response" value="Fed-Ex">Fed-Ex <input type="radio" name="Response" value="Other">Other <input type="text" name="ResponseOther" size="20"></p>
<p>Response Time Frame: <select name="TimeFrame" size="1">
<option selected value="Normal">Normal</option>
<option value="Rush">Rush</option>
</select></p>
<p> </p>
</blockquote>
<p><input TYPE="submit" VALUE="Submit Form"> <input TYPE="RESET" VALUE="Reset Form"> </p>
</form>
<!--msthemeseparator--><p align="center"><img src="_themes/indust/indhorsa.gif" width="300" height="10"></p>
<h5><!--mstheme--><font color="#993399">Copyright Schellin and Associates<br>
Last revised: <!--webbot bot="TimeStamp" S-Type="EDITED" S-Format="%B %d, %Y" startspan -->January 25, 1999<!--webbot bot="TimeStamp" endspan i-checksum="32824" --><!--mstheme--></font></h5>
<!--mstheme--></font><!--msnavigation--></td></tr><!--msnavigation--></table></body>
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