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<body bgcolor="#FFFFFF"> <table border="0"> <tr> <td><font size="5" face="Arial"><strong>ENQUIRY FORM</strong></font></td> </tr> </table> <form action="http://www.bfinternet.co.uk/cgi-bin/formmail.pl" method="POST"> <INPUT TYPE=hidden name="recipient" value="info@allied-billiards.co.uk"> <INPUT TYPE=hidden name="email" value="info@allied-billiards.co.uk"> <input type="hidden" name="subject"value="Allied Billiards Internet Feedback Form"> <INPUT TYPE=hidden name="redirect" value="http://www.allied-billiards.co.uk/thanks.htm"> <blockquote> <div align="center"><center><table border="0" cellpadding="4" cellspacing="0"> <tr> <td align="right" valign="top"><font color="#004040" size="3" face="Arial"><strong>Name:</strong></font></td> <td colspan="2"><font color="#000000" size="4" face="Arial"><input type="text" size="25" name="Name"></font></td> </tr> <tr> <td align="right" valign="top"><font color="#004040" size="3" face="Arial"><strong>Address:</strong></font></td> <td colspan="2"><font color="#000000" face="Arial"><textarea name="Address" rows="3" cols="30"></textarea></font></td> </tr> <tr> <td align="right" valign="top"><font color="#004040" size="3" face="Arial"><strong>Postcode:</strong></font></td> <td colspan="2"><font color="#000000" size="4" face="Arial"><input type="text" size="25" name="Postcode"></font></td> </tr> <tr> <td align="right" valign="top"><font color="#004040" size="3" face="Arial"><strong>Tel No.</strong></font></td> <td colspan="2"><font color="#000000" size="4" face="Arial"><input type="text" size="25" name="Tel no."></font></td> </tr> <tr> <td align="right" valign="top"><font color="#004040" size="3" face="Arial"><strong>Fax No.</strong></font></td> <td colspan="2"><font color="#000000" size="4" face="Arial"><input type="text" size="25" name="Fax no."></font></td> </tr> <tr> <td align="right" valign="top"><font color="#004040" size="3" face="Arial"><strong>E-mail:</strong></font></td> <td colspan="2"><font color="#000000" size="4" face="Arial"><input type="text" size="25" name="e-mail"></font></td> </tr> <tr> <td align="right" valign="top"><font color="#004040" size="2" face="Arial"><strong>I am interested in <br> the following product: </strong></font></td> <td colspan="2"><font color="#000000" face="Arial"><textarea name="Description of product" rows="3" cols="30"></textarea></font></td> </tr> <tr> <td align="right" colspan="3"><table border="0" width="100%"> <tr> <td><font color="#004040" size="2" face="Arial">Please highlight box if you require an immediate Call back from Sales</font></td> <td><font color="#004040" size="2" face="Arial"><strong><input type="checkbox" name="I require Immediate Call back from Sales" value="ON"></strong></font></td> </tr> </table> </td> </tr> <tr> <td align="right"><font color="#004040" size="2" face="Arial"><strong>How did you <br> hear about us</strong></font></td> <td colspan="2"><font color="#000000" size="4" face="Arial"><input type="text" size="25" name="How did you hear about us"></font></td> </tr> <tr> <td align="right" valign="top"><font color="#004040" size="2" face="Arial"><strong>Other comments:</strong></font></td> <td colspan="2"><font color="#000000" face="Arial"><textarea name="Other comments" rows="3" cols="30"></textarea></font></td> </tr> <tr> <td> </td> <td> </td> <td> </td> </tr> <tr> <td align="right" valign="top"> </td> <td align="right" colspan="2"><font color="#000000" face="Arial"><input type="submit" value="Submit"><input type="reset" value="Clear "></font></td> </tr> </table> </center></div> </blockquote> </form> </body>