<?xml version="1.0" encoding="UTF-8"?>

<form url="mitch_survey_form.php"
 window="_self"
 method="POST"
 fontname="MS Sans Serif"
 width="434"
 height="605"
 bkcolor="0xFFFFFF"
 transparent="t"
 fontcolor="0x000000"
 themecolor="0xFFFF99"
 fontcolor2="#000000"
 bkcolor2="#FFFFFF"
 includeresults="false"
 emailuser="true"
 verifymessage="The E-Mail address you entered does not match !"
 reqmessage="One or More Fields are Required"
 transition="0"
 autoresponseincluderesults="t"
 autoresponseaddtotop="t"
 usephp="true"
 disableclicktoactiveprompt="true"
 extensions="*.txt;*.gif;*.jpg;*.jpeg;*.zip;*.doc;*.png;*.pdf;*.rtf"
>

<hidden
 name="thankyoupage"
 value="http://www.customcribbage.com/thanks.htm"
></hidden>

<hidden
 name="subject"
 value="Engraging Order Form"
></hidden>

<image
 image="notepad.jpg"
 x="28"
 y="14"
></image>

<image
 image="run2.jpg"
 x="26"
 y="13"
></image>

<textinput
 name="Name"
 x="160"
 y="52"
 w="175"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
 editable="true"
>
</textinput>

<textinput
 name="Phone"
 x="160"
 y="80"
 w="175"
 h="22"
 initvalue=""
 maxchars="25"
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
 editable="true"
>
</textinput>

<textinput
 name="Email"
 x="160"
 y="108"
 w="175"
 h="22"
 initvalue=""
 maxchars="25"
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
 emailbox="true"
 editable="true"
>
</textinput>

<combobox
 name="Font 1"
 x="20"
 y="208"
 bkcolor="0xFFFFFF"
 fontcolor="0x000000"
 isemail="false"
 w="143"
 h="20">
  <item name="Select Font Line 1"></item>
  <item name="Optima Regular"></item>
  <item name="Optima Bold"></item>
  <item name="Helvetica"></item>
  <item name="Garamond"></item>
  <item name="Times New Roman"></item>
</combobox>

<textarea
 name="My Text Line 1"
 x="20"
 y="232"
 w="393"
 h="20"
 initvalue=""
 maxchars="50"
 editable="true"
 bkcolor="0xFFFFFF"
  fontsize="12"
  fontname="Arial"
  fontcolor="0x000000"
></textarea>

<combobox
 name="Font 2"
 x="20"
 y="280"
 bkcolor="0xFFFFFF"
 fontcolor="0x000000"
 isemail="false"
 w="141"
 h="20">
  <item name="Select Font Line 2"></item>
  <item name="Optima Regular"></item>
  <item name="Optima Bold"></item>
  <item name="Helvetica"></item>
  <item name="Garamond"></item>
  <item name="Times New Roman"></item>
</combobox>

<textarea
 name="My Text Line 2"
 x="20"
 y="304"
 w="394"
 h="24"
 initvalue=""
 maxchars="50"
 editable="true"
 bkcolor="0xFFFFFF"
  fontsize="12"
  fontname="Arial"
  fontcolor="0x000000"
></textarea>

<combobox
 name="Font 3"
 x="20"
 y="344"
 bkcolor="0xFFFFFF"
 fontcolor="0x000000"
 isemail="false"
 w="145"
 h="20">
  <item name="Select Font Line 3"></item>
  <item name="Optima Regular"></item>
  <item name="Optima Bold"></item>
  <item name="Helvetica"></item>
  <item name="Garamond"></item>
  <item name="Times New Roman"></item>
</combobox>

<textarea
 name="My Text Line 3"
 x="20"
 y="368"
 w="394"
 h="23"
 initvalue=""
 maxchars="50"
 editable="true"
 bkcolor="0xFFFFFF"
  fontsize="12"
  fontname="Arial"
  fontcolor="0x000000"
></textarea>

<textarea
 name="Special Instructions"
 x="20"
 y="524"
 w="397"
 h="71"
 initvalue=""
 wordwrap="true"
 editable="true"
 bkcolor="0xFFFFFF"
  fontsize="12"
  fontname="Arial"
  fontcolor="0x000000"
></textarea>

<submitbutton
 name="submitbutton1"
 x="232"
 y="456"
 w="89"
 h="19"
 label="Send"
 fontname="Arial"
 fontcolor="0x000000"
 image="red.jpg"
  fontsize="12"
></submitbutton>

<label
 name="My Text 1"
 x="100"
 y="56"
 w="54"
 h="19"
 text="Name:"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x993300"
  fontsize="16"
></label>

<label
 name="My Text 11"
 x="64"
 y="136"
 w="301"
 h="16"
 text="If you have any questions about ordering these"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x800000"
  fontsize="13"
></label>

<label
 name="My Text 4"
 x="84"
 y="160"
 w="240"
 h="16"
 text="Engraved Plates call me 612-423-1818"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x800000"
  fontsize="13"
></label>

<label
 name="My Text 2"
 x="36"
 y="76"
 w="124"
 h="19"
 text="Contact Phone:"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x800000"
  fontsize="16"
></label>

<label
 name="My Text 3"
 x="44"
 y="92"
 w="97"
 h="14"
 text="(with Area Code)"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x800000"
  fontsize="11"
></label>

<label
 name="My Text 5"
 x="108"
 y="112"
 w="52"
 h="19"
 text="Email:"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x800000"
  fontsize="16"
></label>

<label
 name="My Text 6"
 x="188"
 y="184"
 w="50"
 h="19"
 text="Line 1"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x800000"
  fontsize="16"
></label>

<captcha
 name="My Captcha 1"
 x="16"
 y="396"
 w="133"
 h="100"
 text="Enter Key Here:"
 fnt="Arial"
 fntclr="0x000000"
 fntsize="11"
 bkbdrcolor="0x000000"
 bkfillclr="0xFFFFFF"
 bkdobdr="t"
 bkbdrsolid="t"
 bkdobk="t"
 bkfillalpha="100"
 message="Incorrect key!"
></captcha>

<label
 name="My Text 7"
 x="188"
 y="256"
 w="50"
 h="19"
 text="Line 2"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x800000"
  fontsize="16"
></label>

<label
 name="My Text 8"
 x="188"
 y="328"
 w="50"
 h="19"
 text="Line 3"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x800000"
  fontsize="16"
></label>

<label
 name="My Text 9"
 x="180"
 y="212"
 w="132"
 h="16"
 text="See Samples Below"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x0000FF"
  fontsize="13"
></label>

<label
 name="My Text 10"
 x="184"
 y="284"
 w="132"
 h="16"
 text="See Samples Below"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x0000FF"
  fontsize="13"
></label>

<label
 name="My Text 12"
 x="184"
 y="348"
 w="132"
 h="16"
 text="See Samples Below"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x0000FF"
  fontsize="13"
></label>

<label
 name="My Text 13"
 x="108"
 y="12"
 w="241"
 h="29"
 text="ENGRAVING ORDER"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x0000FF"
  fontsize="23"
></label>

<label
 name="My Text 14"
 x="152"
 y="420"
 w="277"
 h="16"
 text="Enter key code  then click on submit button"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x0000FF"
  fontsize="13"
></label>

<label
 name="My Text 15"
 x="160"
 y="500"
 w="128"
 h="16"
 text="Special Instructions"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x800000"
  fontsize="13"
></label>

</form>