<center><h1><strong>FREE TRIAL</strong></h1>
Right now you can try the circuit for free. Just fill out the form <br />below.
<div class="form_item">
  <div class="form_element cf_textbox">
    <label class="cf_label" style="width: 100px;">Name</label>
    <input class="cf_inputbox required" maxlength="150" size="20" title="please select name" id="text_0" name="text_0" type="text" />
  
  </div>
  <div class="cfclear">&nbsp;</div>
</div>


<div class="form_item">
  <div class="form_element cf_textbox">
    <label class="cf_label" style="width: 100px;">Phone</label>
    <input class="cf_inputbox" maxlength="150" size="20" title="{cf_title}" id="text_6" name="text_6" type="text" />
  
  </div>
</div>

<div class="form_item">
  <div class="form_element cf_textbox">
    <label class="cf_label" style="width: 100px;">Email</label>
    <input class="cf_inputbox validate-email" maxlength="150" size="20" title="" id="text_4" name="text_4" type="text" />
  
  </div>
  <div class="cfclear">&nbsp;</div>
</div>

<div class="form_item">
  <div class="form_element cf_dropdown">
    <label class="cf_label" style="width: 100px;">Location</label>
    <select class="cf_inputbox validate-selection" id="select_10" size="1" title="{cf_title}"  name="USERNAME">
    <option value=""></option>
<option value="Abbotsford">Abbotsford</option>
<option value="Burnaby">Burnaby</option>
<option value="Calgary">Calgary</option>
<option value="edmonton">Edmonton</option>
<option value="Langley">Langley</option>
<option value="Mapleridge">Maple Ridge</option>
<option value="North Vancouver">North Vancouver</option>     
<option value="poco">Port Coquitlam</option>
<option value="richmond">Richmond</option>
<option value="south surrey">South Surrey</option>
<option value="Spanaway">Spanaway</option>
<option value="vancouver">Vancouver</option>







    </select>
    
  </div>
  <div class="cfclear">&nbsp;</div>
</div>

<div class="form_item">
    <input class="cf_hidden" size="20" id="Referer_url" name="Referer_url" value="<?php echo $_SERVER['HTTP_REFERER']; ?>" type="hidden" />
<input class="cf_hidden" size="20" id="radio" name="radio" value="Web" type="hidden" />
  </div>
</div>
<center>
<div class="form_item">
  <div class="form_element cf_button">
    <input value="Submit" name="{cf_name}" type="submit" />
  </div>
</center>
  <div class="cfclear">&nbsp;</div>
</div>
</center>
