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

<form url="reward_reg.php"
 window="_self"
 method="POST"
 fontname="MS Sans Serif"
 width="539"
 height="412"
 bkcolor="0xFFFFFF"
 outlinecolor="0xFFFFFF"
 fontcolor="0x000000"
 themecolor="0xFFFF00"
 fontcolor2="#000000"
 bkcolor2="#FFFFFF"
 includeresults="false"
 emailuser="true"
 reqmessage="One or More Fields are Required"
 autoresponse="Thanks for Registering!">

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

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

<hidden
 name="subject"
 value="Order Rewards Registration"
></hidden>

<textinput
 name="company"
 x="208"
 y="68"
 w="272"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
>
</textinput>

<textinput
 name="first_name"
 x="208"
 y="100"
 w="272"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
>
</textinput>

<textinput
 name="last_name"
 x="208"
 y="128"
 w="272"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
>
</textinput>

<textinput
 name="work_phone"
 x="208"
 y="160"
 w="272"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
>
</textinput>

<textinput
 name="cell_phone"
 x="208"
 y="188"
 w="272"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
>
</textinput>

<textinput
 name="email"
 x="208"
 y="220"
 w="272"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
>
</textinput>

<submitbutton
 name="Submit Button 1"
 x="392"
 y="372"
 w="100"
 h="25"
 label="Submit"
 fontname="Arial"
 fontcolor="0x000000"
 fontbold="bold"
  fontsize="12"
></submitbutton>

<label
 name="My Text 1"
 x="8"
 y="6"
 w="161"
 h="19"
 text="www.MosDirect.com"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="16"
></label>

<label
 name="My Text 2"
 x="8"
 y="30"
 w="173"
 h="16"
 text="Martin's Office Supply, Inc."
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 3"
 x="232"
 y="26"
 w="216"
 h="19"
 text="Order Rewards Registration"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="16"
></label>

<label
 name="My Text 4"
 x="116"
 y="102"
 w="85"
 h="16"
 text="*First Name :"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 5"
 x="116"
 y="126"
 w="84"
 h="16"
 text="*Last Name :"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 6"
 x="108"
 y="158"
 w="95"
 h="16"
 text="*Work Phone :"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 7"
 x="120"
 y="190"
 w="82"
 h="16"
 text="Cell Phone :"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 8"
 x="148"
 y="222"
 w="53"
 h="16"
 text="*Email :"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 9"
 x="160"
 y="246"
 w="324"
 h="14"
 text="Please verify that your email address is entered correctly."
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000080"
  fontsize="11"
></label>

<label
 name="My Text 10"
 x="24"
 y="70"
 w="180"
 h="16"
 text="*Company or Organization :"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<list
 name="My List Box 1"
 x="208"
 y="272"
 bkcolor="0xFFFFFF"
 fontcolor="0x000000"
 w="208"
 h="71">
  <item name="Please Choose One..."></item>
  <item name="I normally order online."></item>
  <item name="I normally purchase at retail."></item>
  <item name=""></item>
</list>

</form>
