<?xml version="1.0" encoding="UTF-8"?>

<form url="request_acct.php"
 window="_self"
 method="POST"
 fontname="MS Sans Serif"
 width="500"
 height="600"
 bkcolor="0xFFFFFF"
 transparent="t"
 fontcolor="0x000000"
 themecolor="0xFFFF99"
 fontcolor2="#000000"
 bkcolor2="#FFFFFF"
 includeresults="false"
 emailuser="true"
 verifymessage="The e-mail address you entered does not match!"
 reqmessage="One or More Fields are Required"
 invalidemailmsg="does not appear to be a valid e-mail address. Would you like to change it?"
 transition="0"
 autoresponseincluderesults="t"
 autoresponseaddtotop="t"
 usephp="true"
disableclicktoactiveprompt="false"
 extensions=""
>

<hidden
 name="thankyoupage"
 value="http://www.mosdirect.com"
></hidden>

<hidden
 name="subject"
 value="Accounting Request"
></hidden>

<textinput
 name="name"
 x="192"
 y="60"
 w="267"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
 editable="true"
>
</textinput>

<textinput
 name="company_name"
 x="192"
 y="92"
 w="266"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 editable="true"
>
</textinput>

<textinput
 name="phone_number"
 x="192"
 y="124"
 w="266"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
 editable="true"
>
</textinput>

<textinput
 name="email_address"
 x="192"
 y="156"
 w="265"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 editable="true"
>
</textinput>

<textinput
 name="fax_number"
 x="192"
 y="188"
 w="266"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 editable="true"
>
</textinput>

<textarea
 name="request"
 x="20"
 y="244"
 w="456"
 h="81"
 initvalue=""
 wordwrap="true"
 required="true"
 editable="true"
 bkcolor="0xFFFFFF"
  fontsize="12"
  fontname="Arial"
  fontcolor="0x000000"
></textarea>

<checkbox
 name="contactme"
 x="20"
 y="336"
 w="379"
 h="19"
 label="Please contact me to discuss other accounting related issues."
 labelPos="right"
 value="checked"
 fontbold="bold"
  fontsize="12"
  fontname="Arial"
  fontcolor="0x000000"
></checkbox>

<submitbutton
 name="Submit Button 1"
 x="340"
 y="408"
 w="100"
 h="20"
 label="Submit"
 fontname="Arial"
 fontcolor="0x000000"
 fontbold="bold"
  fontsize="12"
></submitbutton>

<label
 name="My Text 1"
 x="4"
 y="0"
 w="118"
 h="19"
 text="MosDirect.com"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x0000FF"
  fontsize="16"
></label>

<label
 name="My Text 2"
 x="0"
 y="25"
 w="172"
 h="16"
 text="Martin&apos;s Office Supply, Inc."
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 3"
 x="212"
 y="8"
 w="213"
 h="19"
 text="Accounting Request and/or"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="16"
></label>

<label
 name="My Text 4"
 x="96"
 y="56"
 w="82"
 h="16"
 text="*Your Name:"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 5"
 x="72"
 y="88"
 w="114"
 h="16"
 text="*Company Name:"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 6"
 x="40"
 y="120"
 w="140"
 h="16"
 text="*Your Phone Number:"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 7"
 x="52"
 y="152"
 w="130"
 h="16"
 text="Your Email Address:"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 8"
 x="24"
 y="220"
 w="244"
 h="16"
 text="Enter your message or request below:"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 13"
 x="64"
 y="184"
 w="118"
 h="16"
 text="Your Fax Number:"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 14"
 x="368"
 y="438"
 w="53"
 h="16"
 text="Thanks!"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 15"
 x="16"
 y="406"
 w="161"
 h="14"
 text="* Indicates a required  input field."
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="11"
></label>

<label
 name="My Text 9"
 x="16"
 y="354"
 w="427"
 h="16"
 text="Note: Statements, invoices, credits, payments and current balance"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0xFF0000"
  fontsize="13"
></label>

<label
 name="My Text 10"
 x="16"
 y="374"
 w="427"
 h="16"
 text="can be viewed and/or printed from the NetSuite Customer Center."
 fontbold="bold"
  fontname="Arial"
  fontcolor="0xFF0000"
  fontsize="13"
></label>

<label
 name="My Text 11"
 x="250"
 y="25"
 w="194"
 h="19"
 text="Change of Address Form"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="16"
></label>

</form>
