<?php
include "header.php";
include "leftnav.php";
?> 
<td valign="top" class="border"><font color="#669900"> <br>
  <img src="img/customersupport.jpg" width="184" height="21"> <br>
  <br>
  </font> 
  <table>
  <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>
  
  <tr><td colspan=2>&nbsp;</td></tr>
</table>     

  <table>
    <tr> 
      <td colspan=4><b><font color="#669900">Support Type</font></b></td>
    </tr>
    <tr> 
      <td width=1><input type="checkbox" name="system"></td>
      <td>System</td>
      <td><input type="checkbox" name="question"></td>
      <td>Question</td>
    </tr>
    <tr> 
      <td width=1><input type="checkbox" name="install"></td>
      <td>Installation</td>
      <td><input type="checkbox" name="service"></td>
      <td>Services</td>
    </tr>
    <tr> 
      <td width=1><input type="checkbox" name="parts"></td>
      <td>Spare parts </td>
      <td>&nbsp;</td>
      <td>&nbsp;</td>
    </tr>
  </table>

  <br>
  <table>
    <tr> 
      <td width="107">Model: <br> </td>
      <td width="318"><input name="model" type="text" size="33"></td>
    </tr>
    <tr> 
      <td>Date Purchased:<br> </td>
      <td><input name="purchase" type="text" size="33"></td>
    </tr>
    <tr> 
      <td>Serial/Part No:<br> </td>
      <td><input name="seriel" type="text" size="33"></td>
    </tr>
    <tr> 
      <td colspan="2" valign="top">Comments:<br> 
        <textarea name="comm" rows=3 cols=40></textarea> 
      </td>
    </tr>
    <tr> 
      <td colspan=2 align="center"> <div align="left"> 
          <input name="submit" type="submit" value="submit">
          &nbsp; </div></td>
    </tr></form>
  </table>
<p></p>
</td>
<?php
include "footer.php";
?>
<div align="right"></div>
