<h1>Request Quote</h1>
<fieldset>
<legend><span class="akey">C</span>ontact Information</legend>
<p>
  <label for="compname">Company/Family name:</label>
  <input name="compname" type="text" class="txt" id="compname" accesskey="c" value="" />
  <span class="validationErrors">*</span><span class="validationErrors"></span></p>
<p>
  <label for="contactperson">Contact person:</label>
  <input name="contactperson" type="text" class="txt" id="contactperson" value="" />
  <span class="validationErrors">*</span></p>
<p>
  <label for="mobilenum">Mobile number:</label>
  <input name="mobilenum" type="text" class="txt" id="mobilenum" value="" />
</p>
<p>
  <label for="telnum">Telephone number:</label>
  <input name="telnum" type="text" class="txt" id="telnum" value="" />
  <span class="validationErrors">*</span><span class="validationErrors"></span></p>
<p>
  <label for="faxnum">Fax number:</label>
  <input name="faxnum" type="text" class="txt" id="faxnum" value="" />
</p>
<p>
  <label for="email">E-mail Address:</label>
  <input name="email" type="text" class="txt" id="email" value="" />
  <span class="validationErrors">*</span></p>
</fieldset>
<fieldset>
<legend>Your<span class="akey">B</span>usiness</legend>
<p>
  <label for="busdiscript">Write a short description of your business. What is special about it? Why should people choose you?</label>
  <textarea name="busdiscript" cols="23" rows="10" class="txt" id="busdiscript" accesskey="b"></textarea>
  <span class="validationErrors">*</span></p>
<p>
  <label for="buskeywds">List 5 to 10 keywords that best discribe your business:</label>
  <textarea name="buskeywds" cols="23" rows="3" class="txt" id="buskeywds"></textarea>
  <span class="validationErrors">*</span></p>
<p>
  <label for="logo">Do you have a company logo or letterhead?</label>
  <select name="logo" title="">
    <option value="" selected>Choose one</option>
    <option value="Y">Yes</option>
    <option value="N">No</option>
  </select>
  <span class="validationErrors">*</span><span class="validationErrors"></span></p>
<p>
  <label for="missionstat">Mission Statement (if you have one):</label>
  <textarea name="missionstat" cols="23" rows="10" class="txt" id="missionstat"></textarea>
</p>
</fieldset>
<fieldset>
<legend><span class="akey">W</span>ebsite Details</legend>
<p>
  <label for="purpose">Broadly defined purpose:</label>
  <select name="purpose" accesskey="w" title="">
    <option value="">Choose one</option>
    <option value="BP">Business Presence</option>
    <option value="eC">eCommerance</option>
    <option value="FS">Family Site</option>
  </select>
  <span class="validationErrors">*</span><span class="validationErrors"></span></p>
<p>
  <label for="regdomains">Registered domain(s) name (if exists):</label>
  <textarea name="regdomains" cols="23" rows="3" class="txt" id="regdomains"></textarea>
</p>
<p>
  <label for="currpresence">Link to current web presence (if exists):</label>
  <input name="currpresence" type="text" class="txt" id="currpresence" value="" />
</p>
<p>
  <label for="purposestat">List below the purpose statements for the website, in order of importance:</label>
  <textarea name="purposestat" cols="23" rows="5" class="txt" id="purposestat"></textarea>
  <span class="validationErrors">*</span></p>
</fieldset>
<fieldset>
<legend>W<span class="akey">e</span>bsite Design</legend>
<p>
  <label for="maint">Do you wish to update and maintain the site yourself?</label>
  <select name="maint" accesskey="e" title="">
    <option value="" selected>Choose one</option>
    <option value="Y">Yes</option>
    <option value="N">No</option>
  </select>
  <span class="validationErrors">*</span></p>
<p>
  <label for="expvisitors">Who do you expect to visit your site?</label>
  <textarea name="expvisitors" cols="23" rows="3" class="txt" id="expvisitors" accesskey="d"></textarea>
</p>
<p>
  <label for="reasonvisit">Why would the above people visit the site?</label>
  <textarea name="reasonvisit" cols="23" rows="5" class="txt" id="reasonvisit"></textarea>
</p>
<p>
  <label>Please tick the pages you want (if known):</label>
</p>
<p>
<span class="sublabel">
<p>
  <label for="homepage">Home Page</label>
  <span class="altfield">
  <input type="checkbox" name="homepage" value="">
  </span></p>
<p>
  <label for="contactpage">Contact Page</label>
  <span class="altfield">
  <input type="checkbox" name="contactpage" value="">
  </span></p>
<p>
  <label for="aboutus">About Us</label>
  <span class="altfield">
  <input type="checkbox" name="aboutus" value="">
  </span></p>
<p>
  <label for="products">Products</label>
  <span class="altfield">
  <input type="checkbox" name="products" value="">
  </span></p>
<p>
  <label for="services">Services</label>
  <span class="altfield">
  <input type="checkbox" name="services" value="">
  </span></p>
<p>
  <label for="sitemap">Site Map</label>
  <span class="altfield">
  <input type="checkbox" name="sitemap" value="">
  </span></p>
<p>
  <label for="others">Others</label>
  <textarea name="others" cols="23" rows="3" id="others"></textarea>
</p>
</span>
<p>
  <label for="webpref">List any website(s) that you may have visited that appeals to you.</label>
  <textarea name="webpref" cols="23" rows="3" class="txt" id="webpref" accesskey="d"></textarea>
</p>
</span>
</p>
<p>
  <label>Please tick the type of form you may require (if known):</label>
</p>
<p>
<span class="sublabel">
<p>
  <label for="frmguest">Guestbook</label>
  <span class="altfield">
  <input name="frmguest" type="checkbox" id="frmguest" value="">
  </span></p>
<p>
  <label for="frminfo">Request for information</label>
  <span class="altfield">
  <input name="frminfo" type="checkbox" id="frminfo" value="">
  </span></p>
<p>
  <label for="frmsurvey">Survey</label>
  <span class="altfield">
  <input name="frmsurvey" type="checkbox" id="frmsurvey" value="">
  </span></p>
<p>
  <label for="frmcomp">Competion</label>
  <span class="altfield">
  <input name="frmcomp" type="checkbox" id="frmcomp" value="">
  </span></p>
<p>
  <label for="frmother">Other</label>
  <textarea name="frmother" cols="23" rows="3" id="frmother"></textarea>
</p>
</span>
</p>
</fieldset>
 <fieldset>
  <legend>Verification</legend>
  <p>
    <label for="Verification">Enter Code</label>
	{imageverification}
  </p>
  </fieldset>
<div align="center">
  <input name="Request Quote" type="submit" id="Request Quote" value="Submit">
</div>
