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<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="13c785a3.jpg"> <div> <B>thank you</B></div> <div> </div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#FFCC66" TEXT="#080000" background="13dd2b03.jpg"> <div> <A HREF="index.htm" TARGET="_top" TITLE="Elementry Chemicals"><U><B>Home</B></U></A></div> </td> <td valign="top" height=390 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> Thank you for completing the order form,a member of our sales team will be contacting you shortly</div> <bR> <div>   <form name="contactForm" method="post" action="http://www.mycontactform.com/sendform/sendform.php"> <input name="user" type="hidden" id="user" value="harryrayson" /><input name="formid" type="hidden" id="formid" value="193532" /><input name="subject" type="hidden" id="subject" value="Element-ry contact form" /> <table width="100%" style="border: 0px solid #000000; margin: 0; padding: 0; background-color: #FFFFFF;"><tr><td> <table width="100%" border="0" cellspacing="0" cellpadding="5"> <tr bgcolor="#EFEFEF"><td><font color="#000000" size="2" face="Arial"> E-mail Address:<font color="#FF0000"> *</font></font></td><td><input name="email" type="text" id="email" size="20" maxlength="100" /></td></tr><tr bgcolor="#FFFFFF"><td><font color="#000000" size="2" face="Arial">Name/Company<font color="#FF0000"> *</font></font></td><td><font color="#000000" size="2" face="Arial"><input name="q[2]" type="text" value="" size="20" maxlength="" /></font></td></tr><tr bgcolor="#EFEFEF"><td><font color="#000000" size="2" face="Arial">Tel Number + dial code<font color="#FF0000"> *</font></font></td><td><font color="#000000" size="2" face="Arial"><input name="q[3]" type="text" value="" size="20" maxlength="" /></font></td></tr><tr bgcolor="#FFFFFF"><td><font color="#000000" size="2" face="Arial">Product Description</font></td><td><font color="#000000" size="2" face="Arial"><input name="q[4]" type="text" value="" size="25" maxlength="" /></font></td></tr><tr bgcolor="#EFEFEF"><td><font color="#000000" size="2" face="Arial">Type/Grade</font></td><td><font color="#000000" size="2" face="Arial"><input name="q[5]" type="text" value="" size="25" maxlength="" /></font></td></tr><tr bgcolor="#FFFFFF"><td><font color="#000000" size="2" face="Arial">Quantity</font></td><td><font color="#000000" size="2" face="Arial"><input name="q[6]" type="text" value="" size="25" maxlength="" /></font></td></tr><tr bgcolor="#EFEFEF"><td><font color="#000000" size="2" face="Arial">Dimensions/Pack Size</font></td><td><font color="#000000" size="2" face="Arial"><input name="q[8]" type="text" value="" size="25" maxlength="" /></font></td></tr><tr><td colspan="2"><hr size="1" /></td></tr> <tr><td colspan="2"><input name="submit" type="submit" value="Submit" /> <input name="reset" type="reset" value="Reset" /> </td></tr> <tr><td><font color="#FF0000" size="1" face="Verdana, Arial, Helvetica, sans-serif"><b>*</b></font> <font size="1" face="Verdana, Arial, Helvetica, sans-serif">Required</font></td><td align="right"><font size="1" face="Verdana, Arial, Helvetica, sans-serif"><a href="http://www.mycontactform.com">Powered by <strong>myContactForm.com</strong></a></font></td></tr> </table></td></tr></table></form>   </div> <bR> <bR> </td> </tr></table></body>