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<TITLE>The Erbeshoppe Contact Form</TITLE>
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<body background="/images/bkground.jpg" bgcolor="#FFFFFF">
<div align="left">
<table border="0" width="670" cellspacing="0" cellpadding="2">
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        <img border="0" src="../images/erbeShoppe.jpg" width="250" height="44">
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  <td valign="top" width="107" align="center" rowspan="3" bgcolor="#FFEAC9">
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      <strong><font face="Verdana, Arial, Helvetica" size="3">Contact Us</font></strong>
      <form method="POST" action="http://www.theerbeshoppe.com/cgi-bin/FormMail.pl">
      <input type="hidden" name="recipient" value="test" />
      <input type="hidden" name="subject" value="The ErbeShoppe Contact Form" />
      <input type="hidden" name="required" value="realname,email" />       
	  <table border="0" cellpadding="2" cellspacing="0" width="500">
      <input type="hidden" name="return_link_url" value="http://www.theerbeshoppe.com/" />       
	  <table border="0" cellpadding="2" cellspacing="0" width="500">
      <!input type="hidden" name="title" value="The Erbe Shoppe" />
      <table border="0" cellpadding="2" cellspacing="0" width="500">

      <tr>
      <td><font face="Verdana, Arial, Helvetica" size="2">Name:</font></td>
      <td><input type="text" name="realname" size="30" tabindex="1">
          <font face="Verdana, Arial, Helvetica" size="1"> (<font color="#FF0000">required</font>)</font></td>
      </tr>
      <tr>
      <td><font face="Verdana, Arial, Helvetica" size="2">email:</font></td>
      <td><input type="text" name="email" size="30" tabindex="2">
          <font face="Verdana, Arial, Helvetica" size="1"> (<font color="#FF0000">required</font>)</font></td>
      </tr>
      <tr>
      <td><font face="Verdana, Arial, Helvetica" size="2">Phone:</font></td>
      <td><input type="text" name="phone" size="30" tabindex="2">
          <font face="Verdana, Arial, Helvetica" size="1"> (include area code)</font></td>
      </tr>
      <tr>
      <td><font face="Verdana, Arial, Helvetica" size="2">Fax:</font></td>
      <td><input type="text" name="fax" size="30" tabindex="2">
          <font face="Verdana, Arial, Helvetica" size="1"> (include area code)</font></td>
      </tr>
      </table>
        <p><font face="Verdana, Arial, Helvetica" size="2">Address (optional):</font></p>
        <div align="center">
          <center>
          <table border="0" cellpadding="2" cellspacing="0" width="500">
            <tr>
              <td colspan="3">
                <font face="Verdana, Arial, Helvetica" size="2">
                Street number and name&nbsp; Suite/Apt No.</font></td>
            </tr>
            <tr>
              <td colspan="3">
                <input type="text" name="address" size="57" tabindex="3"></td>
            </tr>
            <tr>
              <td width="300">
                <font face="Verdana, Arial, Helvetica" size="2">City</font></td>
              <td width="50">
                <font face="Verdana, Arial, Helvetica" size="2">State</font></td>
              <td width="150">
                <font face="Verdana, Arial, Helvetica" size="2">Zip</font></td>
            </tr>
            <tr>
              <td><font face="Verdana, Arial, Helvetica" size="2">
                <input type="text" name="city" size="30" tabindex="4"></font></td>
              <td><font face="Verdana, Arial, Helvetica" size="2">
                <input type="text" name="state" size="4" tabindex="5"></font></td>
              <td><font face="Verdana, Arial, Helvetica" size="2">
                <input type="text" name="zip" size="10" tabindex="6"></font></td>
            </tr>
          </table>
          </center>
        </div>
        <p><font face="Verdana, Arial, Helvetica" size="2">Comments (optional):<br>
        <textarea rows="2" name="comments" cols="50"></textarea></font></p>
      <p>
      <input type="submit" value="Submit" name="submit">
      <input type="reset" value="Reset" name="reset"></p>
        <input type="hidden" name="subject" value="The Erbeshoppe Contact Form">

</form>
      <p>&nbsp;
    </table></table></TD></TR>
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