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<body>
<table width="459" border="1">
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<td width="449"><table width="448" cellspacing="8" cellpadding="0">
<tr class="homeCenterText">
<td width="180">First Name</td>
<td width="242"><input type="text" name="fname" size="30" /></td>
</tr>
<tr class="homeCenterText">
<td>Last Name</td>
<td><input type="text" name="lname" size="30" /></td>
</tr>
<tr class="homeCenterText">
<td>Email</td>
<td><input type="text" name="email" size="30" /></td>
</tr>
<tr class="homeCenterText">
<td>Phone</td>
<td><input name="phone" type="text" value="(xxx)xxx-xxxx" size="30" /></td>
</tr>
<tr class="homeCenterText">
<td><p>Are you currently looking for a new fountain design?</p>
<p>
<input type="checkbox" name="checkbox" value="checkbox" id="checkbox" />
<label for="checkbox">Yes</label>
<input type="checkbox" name="checkbox2" value="checkbox" id="checkbox2" />
<label for="checkbox2">No</label>
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<tr class="homeCenterText">
<td><p>Please send me information:</p>
<p> </p>
<p> </p></td>
<td><input type="checkbox" name="design[]" value="Fountain Design" />
Fountain Design<br />
<input type="checkbox" name="design[]" value="Fountain Gallery Inquiries" />
Fountain Gallery<br />
<input type="checkbox" name="design[]" value="Home Owners Brochure" />
Request Home Owners Brochure<br />
<input type="checkbox" name="design[]" value="Other" />
Other </td>
</tr>
<tr class="homeCenterText">
<td> </td>
<td><input name="Submit" type="submit" onclick="mailto:mike@old-faithful.com" ondblclick="mailto:mike@old-faithful.com" onkeypress="mailto:mike@old-faithful.com" value="Submit" />
<input name="Reset" type="reset" style="margin-left: 5px;" onselect="clear form" onclick="clear form" ondblclick="clear form" value="Reset" /></td>
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<span class="style58">©Copyright 2005 Old Faithful Fountains, Inc.
972-231-5059</span></a></span></span></div></td>
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