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<!doctype html public "-//w3c//dtd html 4.0 transitional//en"> <html> <head> <meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1"> <meta name="GENERATOR" content="Mozilla/4.8 [en] (Win95; U) [Netscape]"> <title>Snow Rake Order Page</title> </head> <body text="#000080" bgcolor="#FFFFFF" link="#0000EE" vlink="#551A8B" alink="#FF0000"> <form method="post" action="mailto:[email protected]"><input type="hidden" name="form-table" value="samgauto"><input type="hidden" name="form-table" value="samgauto"><input type="hidden" name="subject" value="Snow Rake Order"> <center> <h1> <a href="http://www.samscars.com/sam-sr.htm"><img SRC="sam-logo.gif" ALT="Return to the Snow Rake Page" BORDER=0 height=71 width=351></a></h1></center> <center> <h1> <font color="#000000"><font size=+3>Snow-Rake Order Page</font></font></h1></center> <center><b><font color="#000000"><font size=+2>Fill out the form below. Be sure to click submit to complete the order.</font></font></b> <br><i><font color="#000000"><font size=+1>Shipping and handling on 1 to 8 rakes is 8.95.</font></font></i> <br><i><font color="#000000"><font size=+1>A 5% sales tax will only apply to orders shipping to a Massachusetts address.</font></font></i> <br><i><font color="#000000"><font size=+0>(Please call for shipping rates if your order is greater than 8 rakes).</font></font></i></center> <font face="arial, helvetica"><font color="#000000"><font size=-1>Required fields are indicated with a red asterisk (<span class="redText"></span></font></font><b><font color="#FF0000"><font size=+1>*</font></font></b><font color="#000000"><font size=-1>).</font></font></font> <table WIDTH="586" > <caption> <br><tbody></tbody><tbody></tbody><tbody> <br></tbody></caption> <tr> <td WIDTH="186"><font color="#000000"><b>E-mail </b><font size=-2>Address<span class="redText"></span></font></font><b><font face="arial, helvetica"><font color="#FF0000"><font size=+1>*</font></font></font></b></td> <td WIDTH="335"><input type="text" name="E-mail" size="40"></td> </tr> <tr> <td WIDTH="186"><b><font color="#000000">First & Last Name <span class="redText"></span></font><font face="arial, helvetica"><font color="#FF0000"><font size=+1>*</font></font></font></b></td> <td WIDTH="335"><input type="text" name="Name" size="40"></td> </tr> <tr> <td WIDTH="186"><font color="#000000"><b>Address </b><font size=-1>(no p.o. box)<span class="redText"></span></font></font><b><font face="arial, helvetica"><font color="#FF0000"><font size=+1>*</font></font></font></b></td> <td WIDTH="335"><input type="text" name="Address 1" size="40"></td> </tr> <tr> <td WIDTH="186"><b><font color="#000000">Address</font></b></td> <td WIDTH="335"><input type="text" name="Address 2" size="40"></td> </tr> <tr> <td WIDTH="186"><b><font color="#000000">City <span class="redText"></span></font><font face="arial, helvetica"><font color="#FF0000"><font size=+1>*</font></font></font></b></td> <td WIDTH="335"><input type="text" name="City" size="40"></td> </tr> <tr> <td WIDTH="186"><b><font color="#000000">State <span class="redText"></span></font><font face="arial, helvetica"><font color="#FF0000"><font size=+1>*</font></font></font></b></td> <td WIDTH="335"><input type="text" name="State" size="2"></td> </tr> <tr> <td WIDTH="186"><b><font color="#000000">Zip Code <span class="redText"></span></font><font face="arial, helvetica"><font color="#FF0000"><font size=+1>*</font></font></font></b></td> <td WIDTH="335"><input type="text" name="Zip" size="10"></td> </tr> <tr> <td WIDTH="186"><b><font color="#000000">Daytime Phone <span class="redText"></span></font><font face="arial, helvetica"><font color="#FF0000"><font size=+1>*</font></font></font></b></td> <td WIDTH="335"><input type="text" name="Day Phone" size="20"></td> </tr> <tr> <td><b><font color="#000000">How Did You Find Us?</font></b> <br><font color="#000000"><font size=-1>Ex: Yahoo, Vermont Life,</font></font> <br><font color="#000000"><font size=-1>Car Dealer, etc.</font></font></td> <td VALIGN=TOP><input type="text" name="SOURCE" size="40"></td> </tr> <tr> <td WIDTH="186"><b><font color="#000000">Credit Card # <span class="redText"></span></font><font face="arial, helvetica"><font color="#FF0000"><font size=+1>*</font></font></font></b><font color="#000000"> xxxx-xxxx-xxxx-xxxx</font> <br><font color="#000000">M/C, Visa or Discover</font> <br><font color="#000000"><font size=-1>Sorry, no AMEX</font></font></td> <td VALIGN=TOP WIDTH="335"><input type="text" name="Invoice Number" size="19"></td> </tr> <tr> <td WIDTH="186"><font color="#000000"><b>Expiration Date </b>xx/xx<span class="redText"></span></font><b><font face="arial, helvetica"><font color="#FF0000"><font size=+1>*</font></font></font></b></td> <td WIDTH="335"><input type="text" name="Invoice Date" size="5"></td> </tr> <tr> <td WIDTH="186"><font color="#000000"><b>Number of Personal Snow Rakes </b><font size=-1>w/scraper</font><b> at 18.95@</b></font></td> <td WIDTH="335"><input type="text" name="Number of Personal Rakes" size="3"></td> </tr> <tr> <td COLSPAN="2" WIDTH="335"></td> </tr> <tr> <td WIDTH="186"><b><font color="#000000">Number of Dealer Size Snow Rakes at 23.95@</font></b></td> <td WIDTH="335"><input type="text" name="Number of Dealer Size Rakes" size="3"></td> </tr> <tr> <td WIDTH="186"></td> <td ALIGN=CENTER WIDTH="335"><input type="submit"><input type="reset"></td> </tr> <tr> <td VALIGN=BOTTOM><img SRC="encrypt9583717.gif" ALT="Encrypt" height=16 width=16></td> <td><b><font color="#000000">Click Submit Query when done. </font><font color="#FF0000">Your order has been sent successfully when you see the message: </font><font color="#000000">"Thanks For The Input!" </font></b></td> </tr> </table> </form> <br> <br> <br> <br> <br> <br> </body> </html>