New Client

<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> <A HREF="id73.htm" TARGET="_top" TITLE="BBB"><U>BBB</U></A>   |   <A HREF="id75.htm" TARGET="_top" TITLE="CPCT"><U>CPCT</U></A>   |   <A HREF="id76.htm" TARGET="_top" TITLE="ABKA 2009"><U>ABKA 2009</U></A>   |   <B>New Client</B></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 Client</I></div> <bR> <div> <I> <html> <head> <title>New Customer Reservation Form</title> </head> <body> <form action=MAILTO:gbkreservations@aol.com method="post" enctype="text/plain"> <h3>This form sends an e-mail to gbkreservations@aol.com.</h3> <form> Customer First and Last Name:<br> <input type="text" name ="customerfirstandlastname" size="60"> <br> Street: <br> <input type="text" name="street" size="60"> <br> City, State Zip: <br> <input type="text" name="citystatezip" size="60"> <br> E-Mail: <br> <input type="text" name="email" size="40"> <br> Home Phone: <br> <input type="text" name="homephone" size="40"> <br> Cell Phone: <br> <input type="text" name="cellphone" size="40"> <br> Drop Off Date: <br> <input type="text" name="dropoffdate" size="40"> <br> Pick Up Date: <br> <input type="text" name="pickupdate" size="40"> <br> First Dog's Name: <input type="text" name="firstdogsname" size="40"> <br> First Dog's Breed: <input type="text" name="firstdogsbreed" size="40"> <br> First Dog's Color: <input type="text" name="firstdogscolor" size="40"> <br> First Dog's Date of Birth: <input type="text" name="firstdogsdateofbirth" size="40"> <br> First Dog's Sex: <input type="radio" name="Male" Value="male"> Male <input type="radio" name="Female" Value="female"> Female <br> First Dog Neutered or Spayed: <input type="radio" name="Yes" Value="yes"> Yes <input type="radio" name="No" Value="no"> No <br> Second Dog's Name: <input type="text" name="secondogsname" size="40"> <br> Second Dog's Breed: <input type="text" name="seconddogsbreed" size="40"> <br> Second Dog's Color: <input type="text" name="seconddogscolor" size="40"> <br> Second Dog's Date of Birth: <input type="text" name="seconddogsdateofbirth" size="40"> <br> Second Dog's Sex: <input type="radio" name="Male" Value="male"> Male <input type="radio" name="Female" Value="female"> Female <br> Second Dog Neutered or Spayed: <input type="radio" name="Yes" Value="yes"> Yes <input type="radio" name="No" Value="no"> No <br> Veterinarian's Name: <input type="text" name="veterinariansname" size="70"> <br> Comments:<br> <textarea rows="8" cols="60"> </textarea> <br><br> <input type="submit" value="Send"> <input type="reset" value="Reset"> </form> </body> </html>  </I></div> </td> </tr></table></body>