Cliff Knecht - Sample Request Form

<HTML> <HEAD> <TITLE>Cliff Knecht - Sample Request Form</TITLE> </HEAD> <BODY LINK="#993300" VLINK="#993300" BACKGROUND="images/ghost.gif"> <FORM ACTION="http://www.artrep1.com/cgi-bin/form.cgi" METHOD="POST"> <P> <CENTER> <IMG SRC="images/header.gif" WIDTH="461" HEIGHT="32" ALIGN="BOTTOM" NATURALSIZEFLAG="3"> <P> <FONT FACE="helvetica, arial"> In order to receive a folder of samples, complete and submit<BR> the following form and I will process your request.<BR> Your packet will arrive by first class mail. <BR> <BR> <TABLE width=350 border=0> <TR><TD align=right> <B>Name:</B> </TD> <TD align=left> <INPUT NAME="name" TYPE="text" SIZE="30"> </TD></TR> <TR><TD align=right> <B>Your Title:</B> </TD> <TD align=left> <INPUT NAME="title" TYPE="text" SIZE="30"> </TD></TR> <TR><TD align=right> <B>Company Name:</B> </TD> <TD align=left> <INPUT NAME="company" TYPE="text" SIZE="30"> </td></tr> <tr><td align=right> <B>What type of business?</B> </td> <td align=left> <SELECT NAME="type"> <OPTION SELECTED>Choose One <OPTION>Ad Agency <OPTION>Design Firm <OPTION>Publishing <OPTION>Other </SELECT> </TD></TR> <TR><TD align=right> <B>Street Address:</B> </TD> <TD align=left> <INPUT NAME="street" TYPE="text" SIZE="30"> </TD></TR> <TR><TD align=right> <B>City:</B> </TD> <TD align=left> <INPUT NAME="city" TYPE="text" SIZE="30"> </TD></TR> <TR><TD align=right> <B>State/Provence:</B> </TD> <TD align=left> <INPUT NAME="state" TYPE="text" SIZE="10"> </TD></TR> <TR><TD align=right> <B>Zip/Postal Code</B>: </TD> <TD align=left> <INPUT NAME="zip" TYPE="text" SIZE="10"> </TD></TR> <TR><TD align=right> <B>Phone:</B> </TD> <TD align=left> <INPUT NAME="phone" TYPE="text" SIZE="30"> </TD></TR> <TR><TD align=right> <B>Fax:</B> </TD> <TD align=left> <INPUT NAME="fax" TYPE="text" SIZE="30"> </TD></TR> <TR> <TD align=right> <B>E-mail:</B> </TD> <TD align=left> <INPUT NAME="email" TYPE="text" SIZE="30"> </TD></TR> </TABLE> <BR> <B>You can type a message here.</B> <BR> <TEXTAREA NAME="comment" ROWS="4" COLS="47"> </TEXTAREA> <P> <INPUT TYPE="submit" VALUE="Submit Request"> <P> You can also reach me by: <P> <font color="#993300"> TEL 412.761.5666 <A HREF="fablefr.html" onMouseOver="window.status='Cliff Knecht - A Shepherd of Sorts';return true"><IMG SRC="images/wsmhead.gif" ALIGN="MIDDLE" BORDER="0"></A> FAX 412.761.4072 <BR> 309 WALNUT ROAD <BR> PITTSBURGH, PA 15202 <BR> <A HREF="mailto:mail@artrep1.com">mail@artrep1.com</A> </font> <P> <PRE><FONT FACE="helvetica, arial"><A HREF="homefr.html" target="_top" onMouseOver="window.status='Home Page';return true">Home</A> | <A HREF="artistsfr.html" target="_top" onMouseOver="window.status='Artist Portfolios';return true">Artist Portfolios</A> | <A HREF="cgi-bin/image_db/query.cgi?page=query.html" target="_blank" onMouseOver="window.status='Search the stock image database';return true">Stock Images</A> | <A HREF="requestfr.html" target="_top" onMouseOver="window.status='Request Samples';return true">Request Samples</A> | <A HREF="mailto:mail@artrep1.com" onMouseOver="window.status='Click here to send Cliff a message.';return true">E-mail</A></PRE> </FORM> </CENTER> </BODY> </HTML>