/*--- Avanquest WebEasy Custom Script ---*/

<form method="post" action="/_ihnextras/cgi/cgishell.exe?replytovendor"><BR>  
		<BR>  
		<BR>  
		<input type="hidden" name="recipient" value="info@waltsdixiechopper.com"><BR>  
		<BR>  
		<pre><BR>  
		<BR>  
		*Name :   <input type="text" name="req-name" size="40"><BR>  
		*Email :  <input type="text" name="req-email" size="40"><BR>  
		Address:  <input type="text" name="address" size="40"><BR>  
		City:     <input type="text" name="city" size="40"><BR>  
		State:    <input type="text" name="state" size="40"><BR>  
		*Phone:   <input type="text" name="req-Phonenumber" size="40"><BR>  
		<BR>  
		Subject:  <input type="text" name="Subject" size="40"><BR>  
		<BR>  
		Comments:<BR>  
		<BR>  
		<textarea name="comments" cols="40" rows="8"></textarea><BR>  
		<BR>  
		<input type=submit value="Submit" name="submit"><input type=reset name="reset"><BR>  
		<BR>  
		</pre><BR>  
		<BR>  
		</form>

/*--- EndOfFile ---*/
