<?xml version="1.0" encoding="UTF-8"?>

<form url="netsuite_cc.php"
 window="_self"
 method="POST"
 fontname="MS Sans Serif"
 width="500"
 height="500"
 bkcolor="0xFFFFFF"
 outlinecolor="0xFFFFFF"
 fontcolor="0x000000"
 themecolor="0xFFFF99"
 fontcolor2="#000000"
 bkcolor2="#FFFFFF"
 includeresults="false"
 emailuser="false"
 reqmessage="One or More Fields are Required"
 autoresponse="">

<hidden
 name="thankyoupage"
 value="http://www.mosdirect.com"
></hidden>

<hidden
 name="mailto"
 value="info@mosdirect.com"
></hidden>

<hidden
 name="subject"
 value="NetSuite Access Request"
></hidden>

<textinput
 name="name"
 x="204"
 y="108"
 w="267"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
>
</textinput>

<textinput
 name="company_name"
 x="204"
 y="140"
 w="266"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
>
</textinput>

<textinput
 name="phone_number"
 x="204"
 y="168"
 w="266"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
>
</textinput>

<textinput
 name="email_address"
 x="204"
 y="200"
 w="265"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
>
</textinput>

<textinput
 name="fax_number"
 x="204"
 y="228"
 w="266"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
>
</textinput>

<checkbox
 name="contact_me"
 x="112"
 y="292"
 w="362"
 h="19"
 label="   Please contact me to discuss other account related issues."
 labelPos="right"
 value="checked"
 fontbold="bold"
  fontsize="12"
  fontname="Arial"
  fontcolor="0x000000"
></checkbox>

<textinput
 name="password"
 x="206"
 y="260"
 w="265"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
>
</textinput>

<submitbutton
 name="Submit Button 1"
 x="372"
 y="320"
 w="101"
 h="20"
 label="Submit"
 fontname="Arial"
 fontcolor="0x000000"
 fontbold="bold"
  fontsize="12"
></submitbutton>

<label
 name="My Text 1"
 x="4"
 y="-4"
 w="160"
 h="19"
 text="www.mosdirect.com"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="16"
></label>

<label
 name="My Text 2"
 x="4"
 y="16"
 w="159"
 h="16"
 text="Martin's Office Supply, Inc."
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 3"
 x="208"
 y="6"
 w="263"
 h="19"
 text="NetSuite Customer Center Access"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="16"
></label>

<label
 name="My Text 4"
 x="108"
 y="106"
 w="83"
 h="16"
 text="Your Name*:"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 5"
 x="80"
 y="138"
 w="109"
 h="16"
 text="Company Name:"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 6"
 x="48"
 y="166"
 w="141"
 h="16"
 text="Your Phone Number*:"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 7"
 x="60"
 y="198"
 w="131"
 h="16"
 text="Your Email Address:"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 13"
 x="72"
 y="226"
 w="119"
 h="16"
 text="Your Fax Number:"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 14"
 x="420"
 y="358"
 w="53"
 h="16"
 text="Thanks!"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 15"
 x="28"
 y="358"
 w="161"
 h="14"
 text="* Indicates a required  input field."
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="11"
></label>

<label
 name="My Text 8"
 x="8"
 y="46"
 w="444"
 h="16"
 text="Note!  Customer Center access is limited to principals, owners and/or "
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x0000FF"
  fontsize="13"
></label>

<label
 name="My Text 9"
 x="12"
 y="66"
 w="441"
 h="16"
 text="authorized accounts payable personnel.  We may need to verify your"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x0000FF"
  fontsize="13"
></label>

<label
 name="My Text 10"
 x="12"
 y="86"
 w="270"
 h="16"
 text="position before a password wiil be issued."
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x0000FF"
  fontsize="13"
></label>

<label
 name="My Text 11"
 x="52"
 y="262"
 w="140"
 h="16"
 text="Requested Password:"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

</form>
