Contact Us :: Brazen Image Ltd website design

<body> <div align="center"><center><table border="0" cellpadding="0" cellspacing="0" width="100%"> <tr> <td width="100%" colspan="3" bgcolor="#000000"><p align="right"><img src="images/top2logo.gif" alt="top2logo.gif (2386 bytes)" WIDTH="258" HEIGHT="58"></td> </tr> <tr> <td width="15%"></td> <td width="68%"><font face="Verdana" size="2" color="#EE4B15">Contact Us</font><form method="POST" action="_vti_bin/shtml.dll/contact.htm" webbot-action="--WEBBOT-SELF--"> <strong>[FrontPage Save Results Component]</strong><div align="center"><center><table border="0" cellpadding="0" cellspacing="0" width="100%"> <tr> <td width="16%" valign="top"><font face="Verdana" size="2" color="#000000">Name:</font></td> <td width="34%" valign="top"><input type="text" name="Name" size="20"></td> <td width="15%" valign="top"><font face="Verdana" size="2" color="#000000">Phone:</font></td> <td width="35%" valign="top"><input type="text" name="Phone" size="20"></td> </tr> <tr> <td width="16%" valign="top"><font face="Verdana" size="2" color="#000000">Company:</font></td> <td width="34%" valign="top"><input type="text" name="Company" size="20"></td> <td width="15%" valign="top"><font face="Verdana" size="2" color="#000000">Email:</font></td> <td width="35%" valign="top"><input type="text" name="Email" size="20"></td> </tr> <tr> <td width="16%" valign="top"><font face="Verdana" size="2" color="#000000">Industry:</font></td> <td width="34%" valign="top"><input type="text" name="Industry" size="20"></td> <td width="15%" valign="top"><font face="Verdana" size="2" color="#000000">Address:</font></td> <td width="35%" valign="top"><textarea rows="3" name="Address" cols="20"></textarea></td> </tr> </table> </center></div><div align="center"><center><table border="0" cellpadding="0" cellspacing="0" width="100%"> <tr> <td width="100%" colspan="4"><font face="Verdana" size="2" color="#000000">I am interested in the following services:<br>   </font></td> </tr> <tr> <td width="25%"><font face="Verdana" size="2" color="#000000">Website Design: </font></td> <td width="17%"><input type="checkbox" name="Want_webdesign" value="ON"></td> <td width="33%"><font face="Verdana" size="2" color="#000000">Image design/animations: </font></td> <td width="25%"><input type="checkbox" name="Want_imageorani" value="ON"></td> </tr> <tr> <td width="25%"><font face="Verdana" size="2" color="#000000">Website Re-design: </font></td> <td width="17%"><input type="checkbox" name="Want_redesign" value="ON"></td> <td width="33%"><font face="Verdana" size="2" color="#000000">Free Factpack: </font></td> <td width="25%"><input type="checkbox" name="Want_factpack" value="ON"></td> </tr> <tr> <td width="25%" height="30"></td> <td width="17%" height="30"></td> <td width="33%" height="30"></td> <td width="25%" height="30"></td> </tr> </table> </center></div><div align="center"><center><table border="0" cellpadding="0" cellspacing="0" width="100%" height="46"> <tr> <td width="50%" height="25"><font face="Verdana" size="2" color="#000000">How did you hear about Brazen?</font></td> <td width="50%" height="25"><select name="How_hear" size="1"> <option value="Please select">Please select</option> <option value="Search Engine">Search Engine</option> <option value="Netguide Magazine">Netguide Magazine</option> <option value="Web Business Magazine">Web Business Magazine</option> <option value="Her Business Magazine">Her Business Magazine</option> <option value="Internet Magazine">Internet Magazine</option> <option value="Yellow Pages">Yellow Pages</option> <option value="Netguide's website">Netguide's website</option> <option value="Friend or colleague">Friend or colleague</option> <option value="Saw a Brazen-designed website and liked it">Saw a website by Brazen and liked it</option> <option value="Not telling!">Not telling!</option> <option value="Other">Other (g'on, tell us in the box below)</option> </select></td> </tr> <tr> <td width="50%" height="21"><font face="Verdana" size="2" color="#000000">Comments or Information:</font></td> <td width="50%" height="21"><textarea rows="4" name="Comments" cols="28"></textarea></td> </tr> </table> </center></div><p><input type="submit" value="Send" name="Send"><input type="reset" value="Reset" name="B2"></p> </form> </td> <td width="17%"></td> </tr> </table> </center></div><p align="center"><font face="Verdana" size="2" color="#000000">[<a href="client.htm" target="_top">portfolio</a>] [<a href="design.htm" target="_top">design</a>] [<a href="mkt.htm" target="_top">marketing</a>] [<a href="aboutus.htm" target="_top">about us</a>] [<a href="costs.htm" target="_top">costs</a>] [<a href="contact.htm" target="_top">contact</a>] [<a href="index.htm" target="_top">home</a>]</font></p> </body>