From: Subject: OnlineOrderForm Date: Thu, 9 Apr 2009 16:23:58 -0400 MIME-Version: 1.0 Content-Type: text/html; charset="iso-8859-1" Content-Transfer-Encoding: quoted-printable Content-Location: https://nceyewearinc.sslpowered.com/nceyewearinc.com/images/testForm.php X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2900.5579 OnlineOrderForm</TITL= E> <META http-equiv=3DContent-Type content=3D"text/html; = charset=3Diso-8859-1"> <STYLE type=3Dtext/css>.style2 { FONT-SIZE: 12px } .style3 { COLOR: #ffffff } .style4 { FONT-SIZE: 12px; COLOR: #cccccc } .style6 { FONT-SIZE: 12px; COLOR: #ff0000 } .style11 { FONT-SIZE: 18px } .style12 { FONT-SIZE: 14px; COLOR: #000000 } .style14 { FONT-WEIGHT: bold; FONT-SIZE: 24px; FONT-FAMILY: "Courier New", = Courier,=20 monospace } .style15 { FONT-SIZE: 14px; COLOR: #cccccc } BODY { BACKGROUND-COLOR: #cccccc } .style16 { COLOR: #cccccc } .style26 { FONT-SIZE: 12px; COLOR: #cccccc } .style27 { COLOR: #ff0000 } </STYLE> <META content=3D"MSHTML 6.00.6000.16735" name=3DGENERATOR></HEAD> <BODY> <FORM action=3D/cgi/formmail method=3Dpost <form><INPUT type=3Dhidden=20 value=3Dorders@nceyewearinc.com name=3Drecipient> <LABEL><SPAN = class=3Dstyle6><SPAN=20 class=3Dstyle11>NC Eyewear, Inc. </SPAN><SPAN=20 class=3Dstyle15>................................ = ...............</SPAN><SPAN=20 class=3Dstyle12><SPAN class=3Dstyle14>ORDER FORM</SPAN></SPAN><SPAN = class=3Dstyle2>=20 <SPAN class=3Dstyle16>...........</SPAN></SPAN></SPAN> <SPAN = class=3Dstyle6><SPAN=20 class=3Dstyle2><SPAN class=3Dstyle16><INPUT id=3D'"recipient"' = type=3Dhidden=20 value=3Dorders@nceyewearinc.com name=3D'"recipient"'> = </SPAN></SPAN></SPAN><INPUT class=3Dstyle11 type=3Dsubmit value=3DSubmit = name=3DPOST>=20 <SPAN class=3Dstyle6><SPAN class=3Dstyle2><SPAN=20 class=3Dstyle16>...</SPAN></SPAN></SPAN><SPAN class=3Dstyle6><SPAN=20 class=3Dstyle2><SPAN class=3Dstyle16> .....=20 .........<STRONG>.....</STRONG></SPAN></SPAN><ST rong><A=20 href=3D"mailto:info@nceyewearinc.com"></A></STRONG><BR><SPAN = class=3Dstyle12>111 Old=20 Statesville Road, Ste. A</SPAN></SPAN><SPAN class=3Dstyle6><SPAN = class=3Dstyle12>=20 </SPAN></SPAN><SPAN class=3Dstyle6><SPAN = class=3Dstyle12><BR>Huntersville, NC 28078=20 </SPAN></SPAN><SPAN class=3Dstyle6><SPAN class=3Dstyle12><BR>Toll Free: = 800.948.0025=20 Fax:866.948.0025</SPAN></SPAN><SPAN class=3Dstyle2><BR><BR><INPUT = type=3Dcheckbox=20 value=3Dcheckbox name=3Dcheckbox> NEW ACCOUNT</SPAN></LABEL> <SPAN=20 class=3Dstyle4>......... </SPAN><SPAN class=3Dstyle2><LABEL>DATE:Thu Apr = 9 16:24:07=20 EDT 2009</LABEL> </SPAN><LABEL></LABEL><SPAN=20 class=3Dstyle26><LABEL></LABEL><LABEL><SPAN=20 class=3Dstyle27><!-- #EndDate --></SPAN>.</LABEL> </SPAN><SPAN=20 class=3Dstyle16><LABEL></LABEL><SPAN=20 class=3Dstyle2><LABEL></LABEL><LABEL></LABEL></SPAN></SPAN><SPAN=20 class=3Dstyle4><LABEL>.</LABEL> </SPAN></SPAN><SPAN class=3Dstyle2><SPAN = class=3Dstyle16>.. </SPAN></SPAN><SPAN class=3Dstyle2><SPAN=20 class=3Dstyle16></SPAN><LABEL>SHIP VIA <SELECT name=3Dselect> <OPTION = selected>UPS=20 GROUND</OPTION> <OPTION>UPS 2ND DAY</OPTION> <OPTION>UPS = OVERNIGHT</OPTION>=20 <OPTION>OTHER</OPTION></SELECT>=20 </LABEL><LABEL></LABEL><LABEL></LABEL><LABEL></LABEL></SPAN> <P class=3Dstyle2><LABEL>ACCOUNT NO <INPUT size=3D24 name=3Dtextfield> = </LABEL><SPAN=20 class=3Dstyle3><LABEL><SPAN class=3Dstyle16>............</SPAN></LABEL> = </SPAN><SPAN=20 class=3Dstyle16><LABEL></LABEL></SPAN><LABEL><INPUT type=3Dradio = value=3Dradio=20 name=3DVendor> Kliik</LABEL> <LABEL><INPUT type=3Dradio value=3Dradio = name=3DVendor>=20 Fysh</LABEL> <LABEL><INPUT type=3Dradio value=3Dradio name=3DVendor> = Flexy</LABEL>=20 <LABEL><INPUT type=3Dradio value=3Dradio name=3DVendor> Vivid</LABEL> = <LABEL><INPUT=20 type=3Dradio value=3Dradio name=3DVendor> Other</LABEL> </P> <P class=3Dstyle2><LABEL><SPAN class=3Dstyle3>..</SPAN>ORDERED BY <INPUT = size=3D24=20 name=3Dtextfield5> CONTACT PHONE <INPUT name=3Dtextfield6> </LABEL></P> <P class=3Dstyle2><SPAN class=3Dstyle2><LABEL></LABEL><LABEL>SHIP TO = (NAME &=20 ADDRESS) <SPAN class=3Dstyle16>................................=20 ........................................</SPAN>S PECIAL INSTRUCTIONS = <BR><TEXTAREA name=3Dtextfield4 rows=3D3 cols=3D35></TEXTAREA> = </LABEL></SPAN><SPAN=20 class=3Dstyle3>.<SPAN class=3Dstyle16>....... ........ .</SPAN></SPAN> = <TEXTAREA name=3Dtextfield9 rows=3D3 cols=3D40></TEXTAREA> </P> <P class=3Dstyle2><SPAN class=3Dstyle2><LABEL>BILL TO (NAME & = ADDRESS)<SPAN=20 class=3Dstyle16> ................................................=20 .......................</SPAN>PROMOTIONAL MATERIALS<BR><TEXTAREA = name=3Dtextfield8 rows=3D3 cols=3D35></TEXTAREA>=20 </LABEL><LABEL><SPAN class=3Dstyle16>...................</SPAN> = <TEXTAREA name=3Dtextfield21 rows=3D3 cols=3D40></TEXTAREA> = </LABEL></SPAN><SPAN=20 class=3Dstyle2><BR><LABEL></LABEL><STRONG><BR><LABEL></LABEL><LABEL></LAB= EL><LABEL></LABEL></STRONG></SPAN><STRONG><LABEL><SPAN=20 class=3Dstyle16>...............</SPAN>STYLE<SPAN class=3Dstyle16>=20 .........................................</SPAN> COLOR<SPAN=20 class=3Dstyle16>...............................< /span>SIZE<SPAN=20 class=3Dstyle16>..............................</ span> QTY<SPAN=20 class=3Dstyle16>............</SPAN></LABEL> </STRONG><SPAN=20 class=3Dstyle16><LABEL>.......................</ label> = </SPAN><LABEL><BR><INPUT=20 name=3Dtextfield7> <SPAN class=3Dstyle16>....</SPAN> </LABEL><SPAN=20 class=3Dstyle16><LABEL><INPUT name=3Dtextfield10> </LABEL><LABEL>.... = <INPUT size=3D10=20 name=3Dtextfield11> </LABEL>.... <LABEL><INPUT size=3D10 = name=3Dtextfield12>=20 <BR><INPUT name=3Dtextfield72> .... <INPUT name=3Dtextfield102> .... = <INPUT size=3D10=20 name=3Dtextfield112> .... <INPUT size=3D10 name=3Dtextfield122> = <BR><INPUT=20 name=3Dtextfield73> .... <INPUT name=3Dtextfield103> .... <INPUT = size=3D10=20 name=3Dtextfield113> .... <INPUT size=3D10 name=3Dtextfield123> = <BR><INPUT=20 name=3Dtextfield722> .... <INPUT name=3Dtextfield1022> .... <INPUT = size=3D10=20 name=3Dtextfield1122> .... <INPUT size=3D10 name=3Dtextfield1222> = <BR><INPUT=20 name=3Dtextfield74> .... <INPUT name=3Dtextfield104> .... <INPUT = size=3D10=20 name=3Dtextfield114> .... <INPUT size=3D10 name=3Dtextfield124> = <BR><INPUT=20 name=3Dtextfield723> .... <INPUT name=3Dtextfield1023> .... <INPUT = size=3D10=20 name=3Dtextfield1123> .... <INPUT size=3D10 name=3Dtextfield1223> = <BR><INPUT=20 name=3Dtextfield732> .... <INPUT name=3Dtextfield1032> .... <INPUT = size=3D10=20 name=3Dtextfield1132> .... <INPUT size=3D10 name=3Dtextfield1232> = <BR><INPUT=20 name=3Dtextfield7222> .... <INPUT name=3Dtextfield10222> .... <INPUT = size=3D10=20 name=3Dtextfield11222> .... <INPUT size=3D10 name=3Dtextfield12222> = <BR><INPUT=20 name=3Dtextfield75> .... <INPUT name=3Dtextfield105> .... <INPUT = size=3D10=20 name=3Dtextfield115> .... <INPUT size=3D10 name=3Dtextfield125> = <BR><INPUT=20 name=3Dtextfield724> .... <INPUT name=3Dtextfield1024> .... <INPUT = size=3D10=20 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