New Customer Reservation Form

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" rowspan="2" width=210 BGCOLOR="#99CC99" TEXT="#080000" bgproperties="fixed" background="03f8dfc3.jpg"> <bR> </td> <td valign="top" colspan=2 height=82 BGCOLOR="#CCCC99" TEXT="#080000" bgproperties="fixed" background="0408dfe1esnpes.jpg"> <div> <FONT SIZE="5" COLOR="#000000" FACE="Arial" ><B>Greenbelt Kennels</B></FONT><B>     </B><B>|</B><B>     </B><A HREF="index.htm" TARGET="_top" TITLE="Greenbelt Kennels"><U><B>home</B></U></A></div> <div> <B>New Customer Reservation Form</B>   |   <A HREF="id43.htm" TARGET="_top" TITLE="Returning Customer Reservation Form"><U>Returning Customer Reservation Form</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" height=398 colspan=2 BGCOLOR="#CCCC99" TEXT="#080000" bgproperties="fixed" background="0408dfc3.jpg"> <div> <I>New Customer Reservation Form</I></div> <div>  <form action="/cgi-bin/gbkreserve.pl" method="POST"> <input type="hidden" name="tlx_SortOrder" value="First & Last Name,Street City Zip,Email,Home Phone,Cell Phone,DropOff Date,PickUp Date,Dogs Name,Dogs Breed & Color,Dogs DOB,Dog's Sex - Neutered/Spayed,Veterinarian's Name,Comments"> <input type="hidden" name="returning" value="0"> <input type="hidden" name="tlx_OKMessage" value="Thank you for your boarding request. You will receive a confirmation shortly."> <input type="hidden" name="tlx_Subject" value="A boarding reservation request was submitted."> <input type="hidden" name="tlx_EmailTo" value="gbkreservations@aol.com"> <table cellpadding="0" cellspacing="1" border="0" align="center"> <tr> <td align="left">First & Last Name:<br> <input type="text" name="name" size="50" maxlength="100"></td> </tr> <tr> <td align="left">Street, City Zip:<br> <input type="text" name="address" size="50" maxlength="150"></td> </tr> <tr> <td align="left">Email:<br> <input type="text" name="email" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Home Phone:<br> <input type="text" name="hphone" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Cell Phone:<br> <input type="text" name="cphone" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Drop Off Date:<br> <input type="text" name="dropoff" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Pick Up date:<br> <input type="text" name="pickup" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Dog's Name(s):<br> <input type="text" name="dogsname" size="50" maxlength="100"></td> </tr> <tr> <td align="left">Dog's Breed & Color:<br> <input type="text" name="breedcolor" size="50" maxlength="100"></td> </tr> <tr> <td align="left">Dog's Date of Birth:<br> <input type="text" name="dogsdob" size="14" maxlength="14"></td> </tr> <tr> <td align="left">Dog's Sex - Neutered/Spayed:<br> <input type="text" name="dogssex" size="50" maxlength="100"></td> </tr> <tr> <td align="left">Veterinarian's Name:<br> <input type="text" name="veterinarian" size="30" maxlength="150"></td> </tr> <tr> <td align="left">Comments:<br> <textarea name="comments" rows="2" cols="50"></textarea></td> </tr> <tr> <td align="right"><input type="reset"> <input type="submit" value="Submit Reservation"></td> </tr> </table> </form>  </div> </td> </tr></table></body>