<?xml version="1.0" encoding="UTF-8"?>

<form url="call_back_for_carpet_cleaners_upholstery_cleaning.php"
 window="_self"
 method="POST"
 fontname="MS Sans Serif"
 width="180"
 height="240"
 bkcolor="0xFFFFFF"
 transparent="t"
 fontcolor="0x000000"
 themecolor="0xFFFF99"
 fontcolor2="#000000"
 bkcolor2="#FFFFFF"
 includeresults="false"
 emailuser="true"
 bcc=""
 cc=""
 reqmessage="Please fill in all the fields"
 transition="0"
 autoresponseincluderesults="f"
 autoresponseaddtotop="f"
 usephp="true"
 disableclicktoactiveprompt="true"
 extensions="*.txt;*.gif;*.jpg;*.jpeg;*.zip;*.doc;*.png;*.pdf;*.rtf"
>

<hidden
 name="thankyoupage"
 value="http://www.nglchemdry.co.uk"
></hidden>

<hidden
 name="subject"
 value="A customer would like you to call back"
></hidden>

<textinput
 name="Customers Full Name"
 x="0"
 y="0"
 w="175"
 h="22"
 initvalue="enter full name here"
 bkcolor="0xFFFFFF"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x003D70"
>
</textinput>

<textinput
 name="Telephone number"
 x="0"
 y="44"
 w="175"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x003D70"
 required="true"
  restrict="phone"
>
</textinput>

<label
 name="My Text 1"
 x="-1"
 y="24"
 w="112"
 h="16"
 text="Telephone Number"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 2"
 x="4"
 y="72"
 w="165"
 h="16"
 text="Best time to call  would be?"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<checkbox
 name="call during the morning"
 x="8"
 y="96"
 w="60"
 h="19"
 label="Morning"
 labelPos="right"
 value="checked"
 checked="true"
  fontsize="12"
  fontname="Arial"
  fontcolor="0x000000"
></checkbox>

<checkbox
 name="call during the afternoon"
 x="8"
 y="120"
 w="68"
 h="19"
 label="Afternoon"
 labelPos="right"
 value="checked"
  fontsize="12"
  fontname="Arial"
  fontcolor="0x000000"
></checkbox>

<checkbox
 name="call during the evening"
 x="8"
 y="144"
 w="60"
 h="19"
 label="Evening"
 labelPos="right"
 value="checked"
  fontsize="12"
  fontname="Arial"
  fontcolor="0x000000"
></checkbox>

<textinput
 name="Email address"
 x="0"
 y="188"
 w="175"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x003D70"
 emailbox="true"
  restrict="email"
>
</textinput>

<label
 name="My Text 3"
 x="8"
 y="168"
 w="37"
 h="16"
 text="Email"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<submitbutton
 name="Submit Button"
 x="4"
 y="216"
 w="90"
 h="29"
 label="Submit"
 fontname="Arial"
 fontcolor="0x000000"
 image="submitnobordersmall.png"
  fontsize="12"
></submitbutton>

<resetbutton
 name="Reset Button"
 x="88"
 y="216"
 w="90"
 h="29"
 label="Reset"
 fontname="Arial"
 fontcolor="0x000000"
 image="resetnobordersmall.png"
  fontsize="12"
></resetbutton>

</form>