<?php
include "header.php";
include "leftnav.php";
?> 
<td valign="top" class="border"><br>
  <img src="img/moreinfobutton.jpg" width="184" height="21"> <br>
  <br>
  <table border=0 cellpadding=5 cellspacing=0 width=100%>
  <script lanuage="javascript" src="process.js"></script>
<form TARGET="onload" name="form1" method="post" action="formmail.php" onSubmit="return Process()">
  <tr>
      <td colspan=2><b><font color="#669900">Corporate Information</font></b></td>
  </tr>

  <tr>
    <td width=1>Name:</td><td><input name="name" type="text" size="40"></td>
  </tr>

  <tr>
    <td width=1>Company:</td><td><input name="company" type="text" size="40"></td>
  </tr>

  <tr>
    <td width=1>Phone:</td><td><input name="phone" type="text" size="40"></td>
  </tr>

  <tr>
    <td width=1>Fax:</td><td><input name="fax" type="text" size="40"></td>
  </tr>

  <tr>
    <td width=1>Email:</td><td><input name="email" type="text" size="40"></td>
  </tr>
</table>

<table>
  <tr><td colspan=2>&nbsp;</td></tr>
  <tr>
      <td colspan=2><b><font color="#669900">Please Send</font></b></td>
  </tr>

  <tr>
    <td width=1><input name="brochures" type="checkbox"></td><td>Brochures</td>
  </tr>

  <tr>
    <td width=1><input name="quotation" type="checkbox"></td><td>Quotation</td>
  </tr>

  <tr>
    <td width=1><input name="general" type="checkbox"></td><td>General Information</td>
  </tr>

  <tr><td colspan=2>&nbsp;</td></tr>
  <tr>
      <td colspan=2><b><font color="#669900">Please select the products of your 
        interest:</font></b></td>
  </tr>

  <tr>
    <td width=1><input name="rdi" type="checkbox"></td><td>Research & Development Instruments</td>
  </tr>

  <tr>
    <td width=1><input name="semi" type="checkbox"></td><td>Semiconductors</td>
  </tr>

  <tr>
    <td width=1><input name="vacuum" type="checkbox"></td><td>Vacuum Technology</td>
  </tr>

  <tr>
    <td width=1><input name="bio" type="checkbox"></td><td>Biotechnology</td>
  </tr>

  <tr>
    <td width=1><input name="opt" type="checkbox"></td><td>Optics</td>
  </tr>

  <tr><td colspan=2>&nbsp;</td></tr>
  <tr>
      <td colspan=2><b><font color="#669900">Application for your interest:</font></b></td>
  </tr>

  <tr>
    <td colspan=2><textarea name="application" rows=5 cols=40 wrap=virtual></textarea></td>
  </tr>

  <tr>
      <td colspan=2><font color="#669900"><strong>How did you hear about APP Systems 
        Services?</strong></font></td>
  </tr>

  <tr>
    <td colspan=2>
      <select size="1" name="HearFrom">
      <option selected>--- Please Select ---</option>
      <option>Semicon</option>
      <option>Photonics</option>
      <option>Singapore Electronics
      Trade Directory</option>
      <option>Yellow Pages</option>
      <option>Singapore Exporters</option>
      <option>Konpens</option>
      <option>Green Book</option>
      <option>Others</option>
      </select>
    </td>
  </tr>
  
  <tr>
      <td colspan=2 align="center"> <div align="left">
          <input type="submit" value="submit">
          &nbsp; </div></td>
  </tr>
  <tr><td colspan=2>&nbsp;</td></tr></form>
</table>     
</td>
<?php
include "footer.php";
?>