orderform

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=90 BGCOLOR="#006699" TEXT="#080000" background="13cfd5a3.jpg"> <div> <B>GATEWAYPOWER COMMUNICATIONS</B></div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#FFCC66" TEXT="#080000" background="13dd2b03.jpg"> <div>  <a href="products_and_services.htm" target="_top" csb-linktype="CSBPage"><img src="HTMLobj-1555/o.jpg" alt="BACK" border="0" align="bottom" csb-maintain-proportions="1" width="100" height="20" csb-button="Candy-Green" csb-font="" csb-font-bold="False" csb-font-italic="False" csb-font-strikethrough="False" csb-font-underline="False" csb-font-size="8" csb-font-color-o="0" csb-font-color-h="0" csb-font-color-p="0" csb-font-horiz="Center" csb-font-verti="Center" csb-font-left="0" csb-font-top="0" csb-img-hover="1" csb-img-press="1" csb-img-preload="0" csb-img-backcolor="16777215" onmouseout="javascript:this.src='HTMLobj-1555/o.jpg'" onmouseover="javascript:this.src='HTMLobj-1555/h.jpg'" onmouseup="javascript:this.src='HTMLobj-1555/h.jpg'" onmousedown="javascript:this.src='HTMLobj-1555/p.jpg'"></a>  </div> </td> <td valign="top" height=390 width="100%" BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <I> <form action="http://csbmail.globalscape.com/cgi-bin/csbmail/csbmail.pl" method="POST" enctype="application/x-www-form-urlencoded"><input type="hidden" name="tlx_SortOrder" value="firstName,lastName,address,city,state,zip,phone,email,Are you 18 Yrs of age or older?,Are you 18 Yrs of age or older?,Account Number(if upgrading),Service Provider,Service Provider,Select Purchase Choice,Select Purchase Choice,Select Purchase Choice,Select Purchase Choice,Model Phone,Number of Daytime Minutes,Additional options desired (describe)"><input type="hidden" name="tlx_FormIndex" value="2"><input type="hidden" name="tlx_OKMessage" value="Your order has been submitted. You will be contacted for order verification."><input type="hidden" name="tlx_SendMode" value="1"><input type="hidden" name="tlx_Subject" value="An online order was submitted"><input type="hidden" name="tlx_EmailTo" value="sales@gatewaypower.com"> <table cellpadding="5" cellspacing="1" border="0" align="center"> <tr> <td align="left">First Name: <br> <input type="text" name="firstName" size="30" maxlength="100"> </td> </tr> <tr> <td align="left">Last Name: <br> <input type="text" name="lastName" size="30" maxlength="100"> </td> </tr> <tr> <td align="left">Address : <br> <input type="text" name="address" size="30" maxlength="100"> </td> </tr> <tr> <td align="left">City: <br> <input type="text" name="city" size="30" maxlength="100"> </td> </tr> <tr> <td align="left">State: <br> <input type="text" name="state" size="30" maxlength="100"> </td> </tr> <tr> <td align="left">Zip: <br> <input type="text" name="zip" size="10" maxlength="10"> </td> </tr> <tr> <td align="left">Phone Number: <br> <input type="text" name="phone" size="14" maxlength="14"> </td> </tr> <tr> <td align="left">Email: <br> <input type="text" name="email" size="30" maxlength="100"> </td> </tr> <tr> <td align="left">Are you 18 Yrs of age or older?: <br> <input type="radio" value="Yes" name="Are you 18 Yrs of age or older?" checked>Yes<br></input><input type="radio" value="No" name="Are you 18 Yrs of age or older?">No<br></input> </td> </tr> <tr> <td align="left">Account Number(if upgrading): <br> <input type="text" name="Account Number(if upgrading)" size="30" maxlength="25"> </td> </tr> <tr> <td align="left">Service Provider: <br> <input type="radio" value="Nextel" name="Service Provider" checked>Nextel<br></input><input type="radio" value="Sprint PCS" name="Service Provider">Sprint PCS<br></input> </td> </tr> <tr> <td align="left">Select Purchase Choice: <br> <input type="radio" value="New Account" name="Select Purchase Choice">New Account<br></input><input type="radio" value="Upgrade Account" name="Select Purchase Choice">Upgrade Account<br></input><input type="radio" value="Upgrade Phone" name="Select Purchase Choice">Upgrade Phone<br></input><input type="radio" value="Upgrade Account and Phone" name="Select Purchase Choice">Upgrade Account and Phone<br></input> </td> </tr> <tr> <td align="left">Model Phone: <br> <input type="text" name="Model Phone" size="30" maxlength="100"> </td> </tr> <tr> <td align="left">Number of Daytime Minutes: <br> <input type="text" name="Number of Daytime Minutes" size="30" maxlength="100"> </td> </tr> <tr> <td align="left">Additional options (describe): <br> <textarea name="Additional options desired (describe)" rows="10" cols="30"></textarea> </td> </tr> <tr> <td align="right"> <input type="reset"> <input type="submit" value="Send" name="tlx_send"> </td> </tr> </table> </form>  </I></div> <bR> </td> </tr></table></body>