<br /><span class="contentheading">
					Free Trial		</span>
<br /><br />
<img align="right" style="padding-right:8px" src="images/free_trial.jpg" />
<div style="float:left">
<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="30" id="text_0" name="text_0" type="text" />
  
  </div>
  <div class="clear">&nbsp;</div>
</div>

<div class="form_item">
  <div class="form_element cf_textbox">
    <label class="cf_label" style="width: 100px;">Address</label>
    <input class="cf_inputbox" maxlength="150" size="30" id="text_1" name="text_1" type="text" />
  
  </div>
  <div class="clear">&nbsp;</div>
</div>

<div class="form_item">
  <div class="form_element cf_textbox">
    <label class="cf_label" style="width: 100px;">City</label>
    <input class="cf_inputbox" maxlength="150" size="30" id="text_9" name="text_9" type="text" />
  
  </div>
  <div class="clear">&nbsp;</div>
</div>

<div class="form_item">
  <div class="form_element cf_textbox">
    <label class="cf_label" style="width: 100px;">Postal Code</label>
    <input class="cf_inputbox" maxlength="150" size="30" id="text_5" name="text_5" type="text" />
  
  </div>
  <div class="clear">&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="30" id="text_6" name="text_6" type="text" />
  
  </div>
  <div class="clear">&nbsp;</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="30" id="text_4" name="text_4" type="text" />
  
  </div>
  <div class="clear">&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" {cf_multiple} name="select_10">
    <option value="">Choose Option</option>
      <option value="North Vancouver">North Vancouver</option>
<option value="Port Coquitlam">Port Coquitlam</option>
<option value="South Surrey">South Surrey</option>
<option value="Vancouver">Vancouver</option>
<option value="Richmond">Richmond</option>
<option value="Edmonton">Edmonton</option>
<option value="Maple Ridge">Maple Ridge</option>
    </select>
    
  </div>
  <div class="clear">&nbsp;</div>
</div>

<!-- <div class="form_item">
  <div class="form_element cf_datetimepicker">
    <label class="cf_label" style="width: 80px;">Preferred Date</label>
    <input class="cf_datetime" maxlength="-1" size="15" id="date_9" name="date_9" type="text" />
    
  </div>
-->
  <div class="clear">&nbsp;</div>
</div>

<div class="form_item">
  <div class="form_element cf_textarea">
    <label class="cf_label" style="width: 100px;">Comments</label>
    <textarea class="cf_inputbox" rows="10" id="text_8" cols="20" name="text_8"></textarea>
    
  </div>
  <div class="clear">&nbsp;</div>
</div>

<div class="form_item">
  <div class="form_element cf_button">
    <input value="Submit" type="submit" />
  </div>
  <div class="clear">&nbsp;</div>
</div>
</div>