<!-- Begin --------------- 1-JS/1-CONTACT-FULFILLMENT ----------------------------
document.write('<DIV ALIGN="CENTER">'); 
document.write('<TABLE CLASS="site"  border="0" cellpadding="10" cellspacing="0">'); 
document.write('<TR VALIGN="TOP">'); 	
document.write('<TD WIDTH="100" ALIGN="CENTER"><img src="../IMG/HELP-100.jpg" ALT="Help" border="0"></TD>'); 
document.write('<TD WIDTH="700">'); 
document.write('<H1>Fulfillment Services</H1>');
document.write('</TD></TR></TABLE>');

document.write('<TABLE WIDTH="800" border="0" cellpadding="0" cellspacing="0">'); 
document.write('<TR VALIGN="MIDDLE" ALIGN="CENTER">'); 
document.write('<TD><img src="../PRODUCTS/EMAIL-FORM-800.gif" ALT="EMAIL FORM" border="0"></TD>'); 
document.write('</TR></TABLE>'); 

document.write('<table CLASS="forms" border="0" cellpadding="10" cellspacing="0">'); 
document.write('<tr>'); 
document.write('<form method="POST" action="http://www.spot98.net/cgi-bin/formmail.pl">'); 
document.write('<input type=hidden name="recipient" value="wholesale-setup@spot98.net">'); 
document.write('<input type=hidden name="subject" value="Spot98 Fulfillment Services">'); 
document.write('<input type=hidden name="redirect"  value="http://www.spot98.net/wholesale/fulfillment-account-setup-thanks.html">'); 
document.write('<input type=hidden name="missing_fields_redirect" value="http://www.spot98.net/errors/missing-fields.html">'); 
document.write('<input type="hidden" name="required" value="name,business_name,bus_description,email,email2,phone,location,tax_id,found,refered,fulfillment_products,details">'); 
document.write('<td>Your Name: </TD><td><input type="text" size="40" name="name">'); 
document.write('</TD></tr><tr>'); 
document.write('<td>Business Name: </TD><td><input type="text" size="40" name="business_name">');
document.write('</TD></tr><tr>'); 
document.write('<td>General Buisness Description:</TD><td>'); 
document.write('<select name="bus_description">');  
document.write('<option value="Fashion Brand">Fashion Brand</option>'); 
document.write('<option value="Artist/Designer">Artist/Designer</option>'); 
document.write('<option value="Retail Store Street Location">Retail Store Street Location</option>'); 
document.write('<option value="Internet Online Store">Internet Online Store</option>'); 
document.write('<option value="Arts Showbiz Entertainment">Arts Showbiz Entertainment</option>');
document.write('<option value="Sales Agency/Rep">Sales Agency/Rep</option>'); 
document.write('<option value="Other">Other</option>'); 
document.write('</select> '); 
document.write('</TD></tr><tr>'); 
document.write('<td>Website Address: </TD><td><input type="text" size="40" name="website">');    
document.write('</TD></tr><tr>'); 
document.write('<td>Email Address: </TD><td><input type="text" size="40" name="email">');  
document.write('</TD></tr><tr>'); 
document.write('<td>Confirm Email Address: </TD><td><input type="text" size="40" name="email2">');  
document.write('</TD></tr><tr>'); 
document.write('<td>Telephone: </TD><td><input type="text" size="15" name="phone">'); 
document.write('</TD></tr><tr>'); 
document.write('<td>Where are you Located ? </TD><td>'); 
document.write('<select name="location">');  
document.write('<option value="USA">USA</option>'); 
document.write('<option value="Canada">Canada</option>'); 
document.write('<option value="Europe">Europe</option>'); 
document.write('<option value="Australia">Australia</option>'); 
document.write('<option value="Asia">Asia</option>');  
document.write('<option value="Other">Other</option>'); 
document.write('</select> '); 
document.write('if other: <input type="text" size="15" name="business_type_other">'); 
document.write('</TD></tr><tr>'); 
document.write('<td>Tax ID #: </TD><td><input type="text" size="20" name="tax_id">');  
document.write('</TD></tr>'); 
document.write('</TD></tr><tr>'); 
document.write('<td>How did you Find Us ?</TD>'); 
document.write('<td>'); 
document.write('<select name="found"> '); 
document.write('<option value="Please Select">Please Select</option>'); 
document.write('<option value="Trade Show">Trade Show</option>'); 
document.write('<option value="Search Engine">Search Engine</option>'); 
document.write('<option value="Forum Board">Forum Board</option>'); 
document.write('<option value="Word of Mouth">Word of Mouth</option>'); 
document.write('<option value="TV-Radio-Magazine">TV-Radio-Magazine</option>'); 
document.write('<option value="Other">Other</option>'); 
document.write('</select> '); 
document.write('</TD></tr><tr>'); 
document.write('<td>Who Refered you to us ? </TD><td><input type="text" size="20" name="refered">');  
document.write('</TD></tr><tr>'); 
document.write('<td>What products Fulfillment do you need? ?</TD>'); 
document.write('<td><TEXTAREA NAME="fulfillment_products" ROWS=4 COLS=30></TEXTAREA>'); 
document.write('</TD></tr><tr>'); 
document.write('<td>Please provide a short bio and other details.</TD>'); 
document.write('<td><TEXTAREA NAME="details" ROWS=4 COLS=30></TEXTAREA>'); document.write('</TD></tr><tr>'); 
document.write('<td>-</TD>'); 
document.write('<td>'); 
document.write('<input type="submit" value="Send Email">'); 
document.write('</TD>'); 
document.write('</form>'); 
document.write('</TR></table>'); 
document.write('</DIV>'); 
// End -------------------------------------------------------------------------- -->





