Test 4<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html>
<head>
<base href="http://fs2.formsite.com//romondo/" />
<meta http-equiv="Content-Type" content="text/html;CHARSET=iso-8859-1" />
<title>New Form</title>
<link rel="stylesheet" type="text/css" media="all" href="/include/form/screen4.css" />
<link rel="stylesheet" type="text/css" media="print" href="/include/form/print4.css" />
<style type="text/css" media="all">
body{
background: #000000;
}
a{
color: #0000FF;
}
a:visited{
color: #0000FF;
}
.form_table{
width: 980px;
overflow: hidden;
margin-left: auto;
margin-right: auto;
border: 2px solid #CCCCCC;
background: #0000CC;
font-family: Verdana,Arial,Helvetica,sans-serif;
font-size: 12px;
color: #000000;
}
.segment_header{
margin-top: 3px;
margin-bottom: 0px;
padding-bottom: 1px;
color: #000000;
background: #FFFFFF;
background-repeat: repeat;
}
.q{
padding-left: 10px;
margin-bottom: 10px;
float: left;
display: block;
}
.q .question{
font-weight: bold;
}
.required .icon{
background-image: url(/images/icons/formIcons/requiredStar.png);
background-position: left;
background-repeat: no-repeat;
font-size: 13px;
padding-left: 14px;
}
.q .text_field{
background: #F4F4F4;
border: 2px inset #A2C3DA;
color: #387BA9;
margin-top: 1px;
margin-bottom: 1px;
}
.q .file_upload{
background: #F4F4F4;
border: 2px inset #A2C3DA;
color: #387BA9;
margin-top: 1px;
}
.q .file_upload_button{
margin-top: 2px;
border-color: #A2C3DA;
clear: left;
}
.q .drop_down{
background: #F4F4F4;
border: 2px inset #A2C3DA;
color: #387BA9;
margin-top: 1px;
margin-bottom: 1px;
}
.q .matrix .multi_scale_break{
background-color: #eeeeee !important;
font-weight: normal !important;
background: #EEEEEE !important;
}
.q .matrix th{
color: #000000;
background: #EEEEEE !important;
padding: 2px 2px 2px 2px;
font-weight: bold;
text-align: center;
vertical-align: bottom;
}
.q .matrix td{
padding: 1px 2px 2px 2px;
text-align: center;
border-left: 1px solid #A2C3DA;
white-space: nowrap;
height: 26px;
}
.q .matrix_row_dark td{
color: #000000;
background: #E1EFF8;
}
.q .matrix_row_light td{
color: #000000;
background: #BFDCF0;
}
.outside_container{
width: 980px;
margin-left: auto;
margin-right: auto;
text-align: center;
padding-top: 1em;
padding-bottom: 1em;
font-family: Verdana,Arial,Helvetica,sans-serif;
font-size: 12px;
}
.outside_container .submit_button{
color: #000000;
background: #F4F4F4;
border-style: double;
border-width: 3px;
border-color: #000000;
}
.outside_container .progress_bar{
background: #FFFFFF;
margin: 0;
}
</style>
</head>
<body>
<!--ENDOFADD -->
<form action="http://fs2.formsite.com/form_app/FormSite" method="post" enctype="application/x-www-form-urlencoded" id="FSForm" onsubmit="processSubmit(this);">
<div style="display:none;">
<input type="hidden" name="FormId" size="-1" value="FormResult" />
<input type="hidden" name="UserNbr" size="-1" value="211938" />
<input type="hidden" name="FormNbr" size="-1" value="3" />
<input type="text" name="subject_line" />
<input type="hidden" name="FormKey" size="-1" value="786126111" />
<input type="hidden" name="ElapsedTime" id="ElapsedTime" size="-1" value="0" />
<input type="hidden" name="Referrer" id="Referrer" size="-1" value="" />
</div>
<script type="text/javascript" src="/include/form/form.js"></script>
<script type="text/javascript" src="/include/yahoo/yahoo-dom-event/yahoo-dom-event.js"></script>
<script type="text/javascript" src="/include/yahoo/container/container-min.js"></script>
<link rel="stylesheet" type="text/css" href="/include/yahoo/container/assets/container.css"/>
<script type="text/javascript" src="/include/yahoo/connection/connection-min.js"></script>
<!-- BEGIN_ITEMS -->
<div class="form_table">
<br class="clear"/>
<div id="q0" class="q full_width">
<a class="item_anchor" name="ItemAnchor0"></a>
<div style="text-align:center;"><img src="misc_images/jacket.jpg" alt="image" /></div>
</div>
<br class="clear"/>
<div id="q1" class="q full_width">
<a class="item_anchor" name="ItemAnchor1"></a>
<div class="segment_header" style="width:100%;text-align:Center;"><h1 style="font-size:36px;">Coaches Jacket Order Form</h1></div>
</div>
<br class="clear"/>
<div id="q2" class="q required">
<a class="item_anchor" name="ItemAnchor2"></a>
<label class="question top_question" for="RESULT_TextField-2"><span class="icon"> </span>First Name</label>
<input type="text" name="RESULT_TextField-2" class="text_field" id="RESULT_TextField-2" size="22" />
</div>
<div id="q3" class="q required">
<a class="item_anchor" name="ItemAnchor3"></a>
<label class="question top_question" for="RESULT_TextField-3"><span class="icon"> </span>Last Name</label>
<input type="text" name="RESULT_TextField-3" class="text_field" id="RESULT_TextField-3" size="22" />
</div>
<br class="clear"/>
<div id="q4" class="q required">
<a class="item_anchor" name="ItemAnchor4"></a>
<label class="question top_question" for="RESULT_TextField-4"><span class="icon"> </span>Street Address</label>
<input type="text" name="RESULT_TextField-4" class="text_field" id="RESULT_TextField-4" size="52" />
</div>
<br class="clear"/>
<div id="q5" class="q">
<a class="item_anchor" name="ItemAnchor5"></a>
<label class="question top_question" for="RESULT_TextField-5">Address Line 2<span class="icon"> </span></label>
<input type="text" name="RESULT_TextField-5" class="text_field" id="RESULT_TextField-5" size="52" />
</div>
<br class="clear"/>
<div id="q6" class="q required">
<a class="item_anchor" name="ItemAnchor6"></a>
<label class="question top_question" for="RESULT_TextField-6"><span class="icon"> </span>City</label>
<input type="text" name="RESULT_TextField-6" class="text_field" id="RESULT_TextField-6" size="30" />
</div>
<div id="q7" class="q required">
<a class="item_anchor" name="ItemAnchor7"></a>
<label class="question top_question"><span class="icon"> </span>State</label>
<select name="RESULT_RadioButton-7" class="drop_down">
<option></option>
<option value="Radio-0">Alabama</option>
<option value="Radio-1">Alaska</option>
<option value="Radio-2">Arizona</option>
<option value="Radio-3">Arkansas</option>
<option value="Radio-4">California</option>
<option value="Radio-5">Colorado</option>
<option value="Radio-6">Connecticut</option>
<option value="Radio-7">Delaware</option>
<option value="Radio-8">Florida</option>
<option value="Radio-9">Georgia</option>
<option value="Radio-10">Hawaii</option>
<option value="Radio-11">Idaho</option>
<option value="Radio-12">Illinois</option>
<option value="Radio-13">Indiana</option>
<option value="Radio-14">Iowa</option>
<option value="Radio-15">Kansas</option>
<option value="Radio-16">Kentucky</option>
<option value="Radio-17">Louisiana</option>
<option value="Radio-18">Maine</option>
<option value="Radio-19">Maryland</option>
<option value="Radio-20">Massachusetts</option>
<option value="Radio-21">Michigan</option>
<option value="Radio-22">Minnesota</option>
<option value="Radio-23">Mississippi</option>
<option value="Radio-24">Missouri</option>
<option value="Radio-25">Montana</option>
<option value="Radio-26">Nebraska</option>
<option value="Radio-27">Nevada</option>
<option value="Radio-28">New Hampshire</option>
<option value="Radio-29">New Jersey</option>
<option value="Radio-30">New Mexico</option>
<option value="Radio-31">New York</option>
<option value="Radio-32">North Carolina</option>
<option value="Radio-33">North Dakota</option>
<option value="Radio-34">Ohio</option>
<option value="Radio-35">Oklahoma</option>
<option value="Radio-36">Oregon</option>
<option value="Radio-37">Pennsylvania</option>
<option value="Radio-38">Rhode Island</option>
<option value="Radio-39">South Carolina</option>
<option value="Radio-40">South Dakota</option>
<option value="Radio-41">Tennessee</option>
<option value="Radio-42">Texas</option>
<option value="Radio-43">Utah</option>
<option value="Radio-44">Vermont</option>
<option value="Radio-45">Virginia</option>
<option value="Radio-46">Washington</option>
<option value="Radio-47">West Virginia</option>
<option value="Radio-48">Wisconsin</option>
<option value="Radio-49">Wyoming</option>
<option value="Radio-50">Washington DC</option>
</select>
</div>
<br class="clear"/>
<div id="q8" class="q required">
<a class="item_anchor" name="ItemAnchor8"></a>
<label class="question top_question" for="RESULT_TextField-8"><span class="icon"> </span>Zip Code</label>
<input type="text" name="RESULT_TextField-8" class="text_field" id="RESULT_TextField-8" size="10" maxlength="255" />
</div>
<div id="q9" class="q required">
<a class="item_anchor" name="ItemAnchor9"></a>
<label class="question top_question" for="RESULT_TextField-9"><span class="icon"> </span>Phone Number</label>
<input type="text" name="RESULT_TextField-9" class="text_field" id="RESULT_TextField-9" size="34" maxlength="255" />
</div>
<br class="clear"/>
<div id="q10" class="q required">
<a class="item_anchor" name="ItemAnchor10"></a>
<label class="question top_question" for="RESULT_TextField-10"><span class="icon"> </span>Email Address</label>
<input type="text" name="RESULT_TextField-10" class="text_field" id="RESULT_TextField-10" size="52" />
</div>
<br class="clear"/>
<div id="q11" class="q full_width">
<a class="item_anchor" name="ItemAnchor11"></a>
<div class="segment_header" style="color:#FFFFFF;width:100%;text-align:Center;"><h1 style="font-size:18px;">Jacket Basics</h1></div>
</div>
<br class="clear"/>
<div id="q12" class="q required">
<a class="item_anchor" name="ItemAnchor12"></a>
<label class="question top_question"><span class="icon"> </span><strong>Jacket Color:<img src="misc_images/colors3.jpg" border="0" alt="Color Chart" width="1" height="1" align="right" /><img src="misc_images/colors4.jpg" border="0" alt="Color Chart" width="244" height="39" align="middle" /></strong> <img id="instructions12Button" class="popup_button" src="/images/qbut.gif" style="vertical-align:bottom;" /></label>
<select name="RESULT_RadioButton-12" class="drop_down">
<option></option>
<option value="Radio-0">Black</option>
<option value="Radio-1">Brown</option>
<option value="Radio-2">Crimson</option>
<option value="Radio-3">Gold</option>
<option value="Radio-4">Grey</option>
<option value="Radio-5">Kelly Green</option>
<option value="Radio-6">Lt. Blue</option>
<option value="Radio-7">Navy Blue</option>
<option value="Radio-8">Pink</option>
<option value="Radio-9">Purple</option>
<option value="Radio-10">Royal Blue</option>
<option value="Radio-11">Tan</option>
<option value="Radio-12">Orange</option>
<option value="Radio-13">White</option>
</select>
<script type="text/javascript">
YAHOO.util.Event.addListener("instructions12Button","click",toggleInstructions,['211938','3','786126111','12']);
</script>
</div>
<br class="clear"/>
<div id="q13" class="q required">
<a class="item_anchor" name="ItemAnchor13"></a>
<label class="question top_question"><span class="icon"> </span><strong>Jacket Size:</strong></label>
<select name="RESULT_RadioButton-13" class="drop_down">
<option></option>
<option value="Radio-0">S</option>
<option value="Radio-1">M</option>
<option value="Radio-2">L</option>
<option value="Radio-3">XL</option>
<option value="Radio-4">2XL</option>
<option value="Radio-5">3XL</option>
<option value="Radio-6">4XL</option>
<option value="Radio-7">5XL</option>
<option value="Radio-8">6XL</option>
</select>
</div>
<br class="clear"/>
<div id="q14" class="q required">
<a class="item_anchor" name="ItemAnchor14"></a>
<label class="question top_question"><span class="icon"> </span>Foreground Letter Color: <img src="misc_images/phi.jpg" border="0" alt="Foreground" width="222" height="77" align="absBottom" /></label>
<select name="RESULT_RadioButton-14" class="drop_down">
<option></option>
<option value="Radio-0">Black</option>
<option value="Radio-1">Brown</option>
<option value="Radio-2">Cream</option>
<option value="Radio-3">Crimson</option>
<option value="Radio-4">Grey</option>
<option value="Radio-5">Hot Pink</option>
<option value="Radio-6">Kelly Green</option>
<option value="Radio-7">Light Blue</option>
<option value="Radio-8">Navy Blue(Light)</option>
<option value="Radio-9">Navy Blue(Dark)</option>
<option value="Radio-10">Old Gold</option>
<option value="Radio-11">Tennesse Orange</option>
<option value="Radio-12">Orange</option>
<option value="Radio-13">Purple</option>
<option value="Radio-14">Red</option>
<option value="Radio-15">Royal Blue</option>
<option value="Radio-16">Tan</option>
<option value="Radio-17">Teal</option>
<option value="Radio-18">Vegas Gold</option>
<option value="Radio-19">White</option>
</select>
</div>
<br class="clear"/>
<div id="q15" class="q required">
<a class="item_anchor" name="ItemAnchor15"></a>
<label class="question top_question"><span class="icon"> </span>Background Letter Color:</label>
<select name="RESULT_RadioButton-15" class="drop_down">
<option></option>
<option value="Radio-0">Black</option>
<option value="Radio-1">Brown</option>
<option value="Radio-2">Crimson</option>
<option value="Radio-3">Gold</option>
<option value="Radio-4">Grey</option>
<option value="Radio-5">Kelly Green</option>
<option value="Radio-6">Lt. Blue</option>
<option value="Radio-7">Navy Blue</option>
<option value="Radio-8">Pink</option>
<option value="Radio-9">Purple</option>
<option value="Radio-10">Royal Blue</option>
<option value="Radio-11">Tan</option>
<option value="Radio-12">Orange</option>
<option value="Radio-13">White</option>
</select>
</div>
<br class="clear"/>
<div id="q16" class="q full_width">
<a class="item_anchor" name="ItemAnchor16"></a>
<div class="segment_header" style="width:100%;text-align:Center;"><h1 style="font-size:16px;">Front Of Jacket</h1></div>
</div>
<br class="clear"/>
<div id="q17" class="q full_width">
<a class="item_anchor" name="ItemAnchor17"></a>
<div class="segment_header" style="width:100%;text-align:Center;"><h1 style="font-size:16px;">Left Sleeve</h1></div>
</div>
<br class="clear"/>
<div id="q18" class="q full_width">
<a class="item_anchor" name="ItemAnchor18"></a>
<div class="segment_header" style="width:100%;text-align:Center;"><h1 style="font-size:16px;">Right Sleeve</h1></div>
</div>
<br class="clear"/>
<div id="q19" class="q full_width">
<a class="item_anchor" name="ItemAnchor19"></a>
<div class="segment_header" style="width:100%;text-align:Center;"><h1 style="font-size:16px;">Pockets on Front of Jackets(Optional Add On)</h1></div>
</div>
<br class="clear"/>
<div id="q20" class="q full_width">
<a class="item_anchor" name="ItemAnchor20"></a>
<div class="segment_header" style="font-weight:bold;width:100%;text-align:Center;"><h1 style="font-size:16px;">Back of Jacket</h1></div>
</div>
<br class="clear"/>
<div id="q21" class="q full_width">
<a class="item_anchor" name="ItemAnchor21"></a>
<div class="segment_header" style="font-weight:bold;width:100%;text-align:Center;"><h1 style="font-size:16px;">Fonts and Lettering Styles</h1></div>
</div>
<br class="clear"/>
<div id="q22" class="q full_width">
<a class="item_anchor" name="ItemAnchor22"></a>
<div class="segment_header" style="width:100%;text-align:Center;"><h1 style="font-size:16px;">Additional Information</h1></div>
</div>
<br class="clear"/>
<div id="q23" class="q">
<a class="item_anchor" name="ItemAnchor23"></a>
<label class="question top_question" for="RESULT_TextArea-23">Is there any additional information you would like to tell us about your jacket?<span class="icon"> </span></label>
<textarea name="RESULT_TextArea-23" class="text_field" id="RESULT_TextArea-23" rows="10" cols="60"></textarea>
</div>
<br class="clear"/>
<div id="q24" class="q full_width">
<a class="item_anchor" name="ItemAnchor24"></a>
<div class="segment_header" style="width:100%;text-align:Center;"><h1 style="font-size:16px;">Turnaround Times and Rush Charges"</h1></div>
</div>
<br class="clear"/>
<div id="q25" class="q required">
<a class="item_anchor" name="ItemAnchor25"></a>
<label class="question top_question"><span class="icon"> </span>Turnaround Time and Rush Service:</label>
<table class="inline_grid">
<tr>
<td><input type="radio" name="RESULT_RadioButton-25" class="multiple_choice" id="RESULT_RadioButton-25_0" value="Radio-0" /><label for="RESULT_RadioButton-25_0" >Standard</label></td>
</tr>
<tr>
<td><input type="radio" name="RESULT_RadioButton-25" class="multiple_choice" id="RESULT_RadioButton-25_1" value="Radio-1" /><label for="RESULT_RadioButton-25_1" >3 Week Rush(Additional $125)</label></td>
</tr>
<tr>
<td><input type="radio" name="RESULT_RadioButton-25" class="multiple_choice" id="RESULT_RadioButton-25_2" value="Radio-2" /><label for="RESULT_RadioButton-25_2" >1 Week Rush(Approval Required - Additional $200)</label></td>
</tr>
</table>
</div>
<br class="clear"/>
<div id="q26" class="q full_width">
<a class="item_anchor" name="ItemAnchor26"></a>
<div class="segment_header" style="font-weight:bold;width:100%;text-align:Center;"><h1 style="font-size:16px;">Payment Options:</h1></div>
</div>
<br class="clear"/>
<div id="q27" class="q required">
<a class="item_anchor" name="ItemAnchor27"></a>
<label class="question top_question" for="RESULT_TextField-27"><span class="icon"> </span>Name on Card</label>
<input type="text" name="RESULT_TextField-27" class="text_field" id="RESULT_TextField-27" size="25" />
</div>
<br class="clear"/>
<div id="q28" class="q">
<a class="item_anchor" name="ItemAnchor28"></a>
<div style="text-align:left;"><img src="/images/stock/visa.gif" alt="Visa" /></div>
</div>
<div id="q29" class="q">
<a class="item_anchor" name="ItemAnchor29"></a>
<div style="text-align:left;"><img src="/images/stock/master_card.gif" alt="MasterCard" /></div>
</div>
<div id="q30" class="q">
<a class="item_anchor" name="ItemAnchor30"></a>
<div style="text-align:left;"><img src="/images/stock/amex.gif" alt="American Express" /></div>
</div>
<div id="q31" class="q">
<a class="item_anchor" name="ItemAnchor31"></a>
<div style="text-align:left;"><img src="/images/stock/discover.gif" alt="Discover" /></div>
</div>
<br class="clear"/>
<div id="q32" class="q required">
<a class="item_anchor" name="ItemAnchor32"></a>
<label class="question top_question"><span class="icon"> </span>Credit Card Type</label>
<select name="RESULT_RadioButton-32" class="drop_down">
<option></option>
<option value="Radio-0">Visa</option>
<option value="Radio-1">MasterCard</option>
<option value="Radio-2">American Express</option>
<option value="Radio-3">Discover</option>
</select>
</div>
<br class="clear"/>
<div id="q33" class="q required">
<a class="item_anchor" name="ItemAnchor33"></a>
<label class="question top_question" for="RESULT_TextField-33"><span class="icon"> </span>Credit Card Number</label>
<input type="text" name="RESULT_TextField-33" class="text_field" id="RESULT_TextField-33" size="25" maxlength="16" />
</div>
<div id="q34" class="q required">
<a class="item_anchor" name="ItemAnchor34"></a>
<label class="question top_question" for="RESULT_TextField-34"><span class="icon"> </span>CSC Code <img id="instructions34Button" class="popup_button" src="/images/qbut.gif" style="vertical-align:bottom;" /></label>
<input type="text" name="RESULT_TextField-34" class="text_field" id="RESULT_TextField-34" size="7" maxlength="4" />
<script type="text/javascript">
YAHOO.util.Event.addListener("instructions34Button","click",toggleInstructions,['211938','3','786126111','34']);
</script>
</div>
<br class="clear"/>
<div id="q35" class="q required">
<a class="item_anchor" name="ItemAnchor35"></a>
<label class="question top_question" for="RESULT_TextField-35"><span class="icon"> </span>Expiration Date (mm/yy)</label>
<input type="text" name="RESULT_TextField-35" class="text_field" id="RESULT_TextField-35" size="25" maxlength="5" />
</div>
<br class="clear"/>
<div class="q required"><span class="icon"> </span>Indicates Response Required
</div>
<br class="clear"/>
</div>
<!-- END_ITEMS -->
<div class="outside_container"><input type="submit" name="Continue" value="Continue >>" class="submit_button" id="FSsubmit" /></div>
</form>
</body>
</html>
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