| |
| |
<!-- Edit.1666 Plugins on RWDTest Server -->
<html>
<head>
<meta http-equiv="content-type" content="text/html;charset=iso-8859-1">
<title>auto register</title>
<style media="screen" type="text/css"><!--
#layer1 { position: absolute; top: 73px; left: 9px; width: 742px; height: 33px; visibility: visible }
#layer2 { position: absolute; top: 6px; left: 5px; width: 144px; height: 67px; visibility: visible }
#layer3 { position: absolute; top: 61px; left: 150px; width: 600px; height: 13px; visibility: visible }
#layer4 { position: absolute; top: 38px; left: 415px; width: 314px; height: 29px; visibility: visible }
#layer5 { position: absolute; top: 100px; left: 9px; width: 742px; height: 13px; visibility: visible }
#layer7 { position: absolute; top: 30px; left: 900px; width: 109px; height: 30px; visibility: visible; display: block }
-->
.formfield{font-family:arial;font-size:13px;color:#000000}
</style>
<style type="text/css">
.headerCSS {font-size:11px;}
.tipsCSS{font-size:20px;bold;}
</style>
<cssequencer default="0">
<cssequence name="Scene 1" fps="15" start="0" end="85" autoplay="on">
<cstrack layer="layer2" parts="0,5,6,,1,1,#ccccff"></cstrack>
<cstrack layer="layer7" parts="0,900,30,,1,1,#ccccff,22,145,30,,1,1,#ccccff,25,273,30,,1,1,#ccccff,30,400,30,,1,1,#ccccff,33,350,30,,1,1,#ccccff,40,150,30,,1,1,#ccccff,42,200,30,,1,1,#ccccff,48,265,30,,1,1,#ccccff,56,155,30,,1,1,#ccccff,61,170,30,,1,1,#ccccff,63,180,30,,1,1,#ccccff,68,165,30,,1,1,#ccccff,71,155,30,,1,1,#ccccff,76,165,30,,1,1,#ccccff,84,155,30,,1,1,#ccccff"></cstrack>
</cssequence>
</cssequencer>
<csscriptdict>
<script type="text/javascript"><!--
CSInit = new Array;
function CSScriptInit() {
if(typeof(skipPage) != "undefined") { if(skipPage) return; }
idxArray = new Array;
for(var i=0;i<CSInit.length;i++)
idxArray[i] = i;
CSAction2(CSInit, idxArray);}
CSAg = window.navigator.userAgent; CSBVers = parseInt(CSAg.charAt(CSAg.indexOf("/")+1),10);
function IsIE() { return CSAg.indexOf("MSIE") > 0;}
function CSIEStyl(s) { return document.all.tags("div")[s].style; }
function CSNSStyl(s) { return CSFindElement(s,0); }
function CSFindElement(n,ly) { if (CSBVers < 4) return document[n];
var curDoc = ly ? ly.document : document; var elem = curDoc[n];
if (!elem) { for (var i=0;i<curDoc.layers.length;i++) {
elem = CSFindElement(n,curDoc.layers[i]); if (elem) return elem; }}
return elem;
}
CSLoopIsRunning = false; CSFctArray = new Array; CSTimeoutID = null;
function CSLoop() {
CSLoopIsRunning = false;
for (i=0;i<CSFctArray.length;i++) {
var curFct = CSFctArray[i];
if (curFct) {
if (curFct.DoFunction(curFct)) { CSLoopIsRunning = true; curFct.counter++; }
else CSFctArray[i] = 0;
}
}
if (CSLoopIsRunning) CSTimeoutID = setTimeout("CSLoop()", 1);
}
function CSStartFunction(fct,data) {
if (!CSLoopIsRunning) { CSFctArray = 0; CSFctArray = new Array; }
var fctInfo = new Object;
fctInfo.DoFunction = fct; fctInfo.counter = 0; fctInfo.data = data;
CSFctArray[CSFctArray.length] = fctInfo;
if (!CSLoopIsRunning) CSLoop();
}
function CSStopFunction(sceneName) {
var i;
for (i=0;i<CSFctArray.length;i++) {
var curFct = CSFctArray[i];
if (curFct){ if (curFct.data.name == sceneName){ CSFctArray[i] = 0; return; } }
}
}
function CSStopComplete() {
if (CSTimeoutID == null) return;
clearTimeout (CSTimeoutID); CSLoopIsRunning = false; CSTimeoutID = null;
}
function CSSetStylePos(s,d,p) { if (IsIE()) { if (d == 0) CSIEStyl(s).posLeft = p; else CSIEStyl(s).posTop = p; }
else { if (d == 0) CSNSStyl(s).left = p; else CSNSStyl(s).top = p; } }
function CSGetStylePos(s,d) { if (IsIE()) { if (d == 0) return CSIEStyl(s).posLeft; else return CSIEStyl(s).posTop; }
else { if (d == 0) return CSNSStyl(s).left; else return CSNSStyl(s).top; }}
function CSSetStyleVis(s,v) { if (IsIE()) CSIEStyl(s).visibility = (v == 0) ? "hidden" : "visible";
else CSNSStyl(s).visibility = (v == 0) ? 'hide' : 'show'; }
function CSGetStyleVis(s) { if (IsIE()) return (CSIEStyl(s).visibility == "hidden") ? 0 : 1;
else return (CSNSStyl(s).visibility == 'hide') ? 0 : 1;}
function CSSetStyleDepth(style,depth) { if (IsIE()) CSIEStyl(style).zIndex = depth; else CSNSStyl(style).zIndex = depth;}
function CSGetStyleDepth(style) { if (IsIE()) return (CSIEStyl(style).zIndex); else return (CSNSStyl(style).zIndex); }
CSSeqArray = new Array;
function CSSeqActionFct(seq,loopCount,continueLoop) {
if ((seq.loop < 2) || ((loopCount % 2) != 0)) {
for (var i=0;i<seq.actionCount;i++) {
if (seq.actions[3*i + 1] <= seq.frame) {
if ((loopCount > 1) && (seq.actions[3*i + 1] < seq.start)) continue;
if (seq.actions[3*i + 2] < loopCount) {
seq.actions[3*i + 2] = loopCount; CSLoopIsRunning = true;
CSAction(new Array(seq.actions[3*i + 0])); continueLoop = true;
}
} else { continueLoop = true; break; }
}
} else {
for (var i=seq.actionCount-1;i>=0;i--) {
if (seq.actions[3*i + 1] > seq.frame) {
if (seq.actions[3*i + 1] > seq.end) continue;
if (seq.actions[3*i + 2] < loopCount) {
seq.actions[3*i + 2] = loopCount; CSLoopIsRunning = true;
CSAction(new Array(seq.actions[3*i + 0])); continueLoop = true;
}
} else { continueLoop = true; break; }
}
}
return continueLoop;
}
function CSSeqFunction(fctInfo)
{
var seq = fctInfo.data; var oldFrame = seq.frame;
var newTicks = (new Date()).getTime();
seq.frame = Math.round((seq.fps * (newTicks - seq.startTicks)/1000.0) - 0.5);
var continueLoop = false; var loopCount = 1;
if (seq.loop > 0) {
continueLoop = true;
if (seq.loop == 1) {
var iv = (seq.end - seq.start);
var f = Math.round(((seq.frame - seq.start) / iv) - 0.5);
if (f < 0) f = 0;
loopCount = f+1;
seq.frame = seq.start + ((seq.frame - seq.start) % (seq.end - seq.start));
} else {
var iv = (seq.end - seq.start);
var f = Math.round(((seq.frame - seq.start) / iv) - 0.5);
if (f < 0) f = 0;
loopCount = f+1;
f = (seq.frame - seq.start) % (2 * iv);
if (f > iv) f = 2*iv - f;
seq.frame = seq.start + f;
}
}
continueLoop = CSSeqActionFct(seq,loopCount,continueLoop);
for (var i=0;i<seq.tracks.length;i++) {
var track = seq.tracks[i]; var frameCount = 0; var lastCount = 0; var partCount = 0;
var partIdx = track.parts.ticks.length;
for (var k=0;k<track.parts.ticks.length;k++) {
frameCount += track.parts.ticks[k];
if (frameCount > seq.frame) { partIdx = k; partCount = seq.frame - lastCount; break; }
lastCount = frameCount;
}
if (partIdx < track.parts.ticks.length) {
var type=track.parts.moveType[partIdx];
if(type==1) CSSetLinearPos (track, partIdx, partCount);
else if(type==2) CSSetCurvePos (track, partIdx, partCount);
else if(type==3) if (oldFrame != seq.frame) CSSetRandomPos (track, partIdx, partCount);
else { x = CSGetStylePos(track.layer,0); y = CSGetStylePos(track.layer,1); }
CSSetStyleVis(track.layer,track.parts.visibilities[partIdx]);
CSSetStyleDepth(track.layer,track.parts.depths[partIdx]);
continueLoop = true;
} else {
var partIdx = track.parts.moveType.length-1;
var posArray = track.parts.positions;
var x = posArray[partIdx * 6 + 0]; var y = posArray[partIdx * 6 + 1];
CSSetStylePos(track.layer,0,x); CSSetStylePos(track.layer,1,y);
CSSetStyleVis(track.layer,track.parts.visibilities[partIdx]);
CSSetStyleDepth(track.layer,track.parts.depths[partIdx]);
}
}
return continueLoop;
}
function CSSetLinearPos (track, partIdx, partCount) {
var curTicks = track.parts.ticks[partIdx];
var pIdx1 = partIdx * 6; var pIdx2 = (partIdx+1) * 6;
var posArray = track.parts.positions;
var x = posArray[pIdx1 + 0]; var y = posArray[pIdx1 + 1];
var x1,x2,y1,y2;
var factor = partCount/curTicks;
x1 = x; y1 = y;
x2 = posArray[pIdx2 + 0]; y2 = posArray[pIdx2 + 1];
x = x1 * (1-factor) + x2 * factor; y = y1 * (1-factor) + y2 * factor;
CSSetStylePos(track.layer,0,x); CSSetStylePos(track.layer,1,y);
}
function CSSetCurvePos (track, partIdx, partCount) {
var curTicks = track.parts.ticks[partIdx];
var pIdx1 = partIdx * 6; var pIdx2 = (partIdx+1) * 6;
var posArray = track.parts.positions;
var x = posArray[pIdx1 + 0]; var y = posArray[pIdx1 + 1];
var x1,x2,x3,x4,y1,y2,y3,y4;
var factor = partCount/curTicks;
var t = factor; var u = t * t; var v = u * t;
var val1 = 3*(u-t) - v + 1; var val2 = 3*(v+t - 2*u); var val3 = 3*(u-v); var val4 = v;
x1 = x; y1 = y; x2 = posArray[pIdx1 + 2]; y2 = posArray[pIdx1 + 3];
x3 = posArray[pIdx1 + 4]; y3 = posArray[pIdx1 + 5];
x4 = posArray[pIdx2 + 0]; y4 = posArray[pIdx2 + 1];
x = x1 * val1 + x2 * val2 + x3 * val3 + x4 * val4;
y = y1 * val1 + y2 * val2 + y3 * val3 + y4 * val4;
CSSetStylePos(track.layer,0,x); CSSetStylePos(track.layer,1,y);
}
function CSSetRandomPos (track, partIdx, partCount) {
var curTicks = track.parts.ticks[partIdx];
var pIdx1 = partIdx * 6; var pIdx2 = (partIdx+1) * 6;
var posArray = track.parts.positions;
var x = posArray[pIdx1 + 0]; var y = posArray[pIdx1 + 1];
var x1,x2,y1,y2;
var factor = partCount/curTicks;
x1 = x; y1 = y;
x2 = posArray[pIdx2 + 0]; y2 = posArray[pIdx2 + 1];
var factorx = Math.random(); var factory = Math.random();
x = x1 * (1-factorx) + x2 * factorx; y = y1 * (1-factory) + y2 * factory;
CSSetStylePos(track.layer,0,x); CSSetStylePos(track.layer,1,y);
}
function CSStartSeq(name) {
var seq = CSGetScene(name); var date = new Date()
seq.startTicks = date.getTime()
for (var i=0;i<seq.actionCount;i++) seq.actions[3*i+2] = 0;
CSStartFunction(CSSeqFunction,seq);
}
function CSSceneObj (name,fps,loop,start,end,frame,sTicks,numAct,acts,tracks) {
this.name=name;this.fps=fps;this.loop=loop;this.start=start;this.end=end;
this.frame=frame;this.startTicks=sTicks;this.actionCount=numAct;
this.actions=acts;this.tracks=tracks;
}
function CSTrackObj (name,partIdx,partCount,parts) {
this.layer=name;this.partIdx=partIdx;this.partCount=partCount;this.parts=parts;
}
function CSPartObj (ticks,pos,depths,vis,moveType) {
this.ticks=ticks;this.positions=pos;this.depths=depths;this.visibilities=vis;
this.moveType=moveType;
}
function CSGetScene (name) {
for (i=0;i<CSSeqArray.length;i++) { var seq = CSSeqArray[i]; if (seq.name==name) return seq; }
return 0;
}
function CSAutoStartScene(action) { CSStartSeq (action[1]); }
CSStopExecution = false;
function CSAction(array) {
return CSAction2(CSAct, array);
}
function CSAction2(fct, array) {
var result;
for (var i=0;i<array.length;i++) {
if(CSStopExecution) return false;
var actArray = fct[array[i]];
if(actArray == null) return false;
var tempArray = new Array;
for(var j=1;j<actArray.length;j++) {
if((actArray[j] != null) && (typeof(actArray[j]) == "object") && (actArray[j].length == 2)) {
if(actArray[j][0] == "VAR") {
tempArray[j] = CSStateArray[actArray[j][1]];
}
else {
if(actArray[j][0] == "ACT") {
tempArray[j] = CSAction(new Array(new String(actArray[j][1])));
}
else
tempArray[j] = actArray[j];
}
}
else
tempArray[j] = actArray[j];
}
result = actArray[0](tempArray);
}
return result;
}
CSAct = new Object;
// --></script>
</csscriptdict>
<csactiondict>
<script type="text/javascript"><!--
CSSeqArray[CSSeqArray.length] = new CSSceneObj(/*CMP*/"Scene 1",15,0,0,85,0,0,0,new Array(),new Array(new CSTrackObj(/*CMP*/"layer7",0,0,new CSPartObj(new Array(22,3,5,3,7,2,6,8,5,2,5,3,5,8,0),new Array(900,30,0,0,0,0,145,30,0,0,0,0,273,30,0,0,0,0,400,30,0,0,0,0,350,30,0,0,0,0,150,30,0,0,0,0,200,30,0,0,0,0,265,30,0,0,0,0,155,30,0,0,0,0,170,30,0,0,0,0,180,30,0,0,0,0,165,30,0,0,0,0,155,30,0,0,0,0,165,30,0,0,0,0,155,30,0,0,0,0),new Array(0,0,0,0,0,0,0,0,0,0,0,0,0,0,0),new Array(1,1,1,1,1,1,1,1,1,1,1,1,1,1,1),new Array(1,1,1,1,1,1,1,1,1,1,1,1,1,1,1)))));
CSInit[CSInit.length] = new Array(CSAutoStartScene,/*CMP*/'Scene 1');
// --></script>
</csactiondict>
<object id=closes type="application/x-oleobject" classid="clsid:adb880a6-d8ff-11cf-9377-00aa003b7a11">
<param name="Command" value="Close">
</object>
</head>
<script language='javascript' >
nextfield = "Send.elements[0]";
prefield = "Send.elements[0]";
netscape = "";
ver = navigator.appVersion; len = ver.length;
for(iln = 0; iln < len; iln++) if (ver.charAt(iln) == "(") break;
netscape = (ver.charAt(iln+1).toUpperCase() != "C");
function keyDown(DnEvents) {
k = (netscape) ? DnEvents.which : window.event.keyCode;
if (k == 13) {
if (nextfield == 'Send')
return true;
else {
eval('Send.elements[' + nextfield + '].focus()');
return false;
}
}
if (k == 38){
eval('Send.elements[' + prefield + '].focus()');
return false;
}
}
document.onkeydown = keyDown;
if (netscape) document.captureEvents(Event.KEYDOWN|Event.KEYUP);
</script>
<!-- begin from send.1000 -->
<script language="JavaScript">
function check(val) {
var value=val;
if (value.indexOf('@') == -1){
alert("The email address is incorrect!");
Send.elements[4].focus( );
Send.elements[4].select( );
}
return false;
}
function passvalue( ) {
if ( checkvalue(Send.elements[0]) && checkvalue(Send.elements[1]) &&
checkvalue(Send.elements[4]) && checkvalue(Send.elements[5])&& checkvalue(Send.elements[24]))
{
return true;
}
else
{
return false;
}
}
function checkvalue(fieldName) {
var value = eval(fieldName).value;
var st="The field:";
if ((value.indexOf(' ')!= -1) && (fieldName.name!="FIELDID:1013=STRING")){
if (fieldName.name=="FIELDID:1007=STRING")
st=st+"First Name is incorrect." ;
if (fieldName.name=="FIELDID:1009=STRING")
st=st+"Last Name is incorrect." ;
if (fieldName.name=="FIELDID:1037=STRING")
st=st+"E-mail address is incorrect." ;
if (fieldName.name=="FIELDID:1031=STRING")
st=st+"Password is incorrect." ;
alert(st);
fieldName.focus( );
fieldName.select( );
return false;
}
if (value == "" || value == "\t" || value == "\s" || value == "\r") {
if (fieldName.name=="FIELDID:1007=STRING")
st=st+"First Name is required." ;
if (fieldName.name=="FIELDID:1009=STRING")
st=st+"Last Name is required." ;
if (fieldName.name=="FIELDID:1037=STRING")
st=st+"E-mail address is required." ;
if (fieldName.name=="FIELDID:1013=STRING")
st=st+"Company Name is required." ;
if (fieldName.name=="FIELDID:1031=STRING")
st=st+"Password is required." ;
alert(st);
fieldName.focus();
return false;
}
return true;
}
</script>
<!-- end of send.1000 -->
<body onload="CSScriptInit();" bgcolor="white" link="#115533" vlink="#115533" alink="#9da20b" align="left">
<!-- added by jacky on June 20 , the menu bar-->
<IFRAME src="https://www.compremed.com/h_access_srv.html" width="100%" height="120" scrolling="no" frameborder="0">
[Your user agent does not support frames or is currently configured
not to display frames. However, you may visit
<A href="h_access_stat.html">the related document.</A>]
</IFRAME>
<!-- end of added iframe -->
<!--
<div id="layer1">
<table border="0" cellpadding="0" cellspacing="2" width="726" gridx="32">
<tr height="29">
<td width="10%" height="10">
<div align="center">
<font face="Tahoma" size="1" color="#115533"><b><a href="http://64.119.109.222/index.html" target="_parent"><span class="headerCSS">Home Page</span></a></b></font></div>
</td>
<td width="4" height="10"><img src="cvert_line.jpg" width="1" height="29" border="0"></td>
<td width="10%" height="10">
<div align="center">
<b><font color="#115533" face="Tahoma" size="1"><a href="http://64.119.109.222/f_about_us.html" target="_parent"><span class="headerCSS">About Us</span></a></font></b></div>
</td>
<td width="4" height="10">
<div align="center">
<img src="cvert_line.jpg" width="1" height="29" border="0"></div>
</td>
<td width="10%" height="10">
<div align="center">
<b><font color="#115533" face="Tahoma" size="1"><a href="http://64.119.109.222/f_Client_srv.html" target="_parent"><span class="headerCSS">Client Services</span></a></font></b></div>
</td>
<td width="4" height="10">
<div align="center">
<img src="cvert_line.jpg" width="1" height="29" border="0"></div>
</td>
<td width="10%" height="10">
<div align="center">
<font face="Tahoma"><b><font color="#115533" size="1"><a href="http://64.119.109.222/f_prov_srv.html" target="_parent"><span class="headerCSS">Provider Services</span></a></font></b></font></div>
</td>
<td width="4" height="10">
<div align="center">
<img src="cvert_line.jpg" width="1" height="29" border="0"></div>
</td>
<td width="10%" height="10">
<div align="center">
<b><font color="#115533" size="1" face="Tahoma"><a href="http://64.119.109.222/f_tech_srv.html" target="_parent"><span class="headerCSS">Technology Services</span></a></font></b></div>
</td>
<td width="4" height="10">
<div align="center">
<img src="cvert_line.jpg" width="1" height="29" border="0"></div>
</td>
<td width="10%" height="10">
<div align="center">
<b><font color="#115533" face="Tahoma" size="1"><span class="headerCSS">On Line Access</span></font></b></div>
</td>
<td width="4" height="10">
<div align="center">
<img src="cvert_line.jpg" width="1" height="29" border="0"></div>
</td>
<td width="10%" height="10">
<div align="center">
<b><font color="#115533" face="Tahoma" size="1"><a href="http://64.119.109.222/f_download.html" target="_parent"><span class="headerCSS">Downloads & Links</span></a><a href="f_download.html" target="_parent"> </a></font></b></div>
</td>
<td height="10" width="4">
<div align="center">
<img src="cvert_line.jpg" width="1" height="29" border="0"></div>
</td>
<td height="10" width="10%">
<div align="center">
<b><font color="#115533" face="Tahoma" size="1"><a href="http://64.119.109.222/privacy.html" target="_parent"><span class="headerCSS">Privacy Policy</span></a></font></b></div>
</td>
<td width="4" height="10" bgColor="white">
<div align="center">
<img src="cvert_line.jpg" width="1" height="29" border="0"></div>
</td>
<td width="10%" height="10">
<div align="center">
<b><font color="#115533" face="Tahoma" size="1"><a href="http://64.119.109.222/f_contact.html" target="_parent"><span class="headerCSS">Contact Us</span></a></font></b></div>
</td>
</tr>
</table>
</div>
-->
<div id="layer2">
<!--
<img src="/images/cmedlogo_sm.jpg" width="144" height="67" border="0">
-->
</div>
<div id="layer7">
<!--
<img src="/images/homepwdBy.gif" alt="" height="30" width="108" border="0">
-->
</div>
<!--
<div id="layer3">
<div align="left">
<hr width="580" size="2" color="#9da20b">
</div>
</div>
<div id="layer4">
<div align="right">
<font face="Tahoma" color="#115533" ><b><span class="tipsCSS">On Line Access</span></b></font></div>
</div>
<div id="layer5">
<div align="left">
<hr width="720" size="2" color="#9da20b">
</div>
</div>
<table cool width="769" height="62" usegridx usegridy showgridx showgridy gridx="16" gridy="16" border="0" cellpadding="0" cellspacing="0" bgcolor="#ffffff">
<tr height="61">
<td width="768" height="61"><spacer type="block" width="768" height="61"></td>
<td width="1" height="61"><spacer type="block" width="1" height="61"></td>
</tr>
<tr height="1" cntrlrow>
<td width="768" height="1"><spacer type="block" width="768" height="1"></td>
<td width="1" height="1"><spacer type="block" width="1" height="1"></td>
</tr>
</table>
<br>
-->
<br>
<!-- table for send.1000 -->
<table>
<tr>
<td>
<!-- added by jacky
<FORM ACTION="<X-FC-OBJURL>/Send?FormID=1000&Unsent" METHOD="POST" ENCTYPE="multipart/form-data" NAME="Send" onSubmit="return passvalue( );">
<font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">
-->
<form ACTION="<X-FC-OBJURL>/Send?FormID=1000<X-FC-IF-UNSENT-MESSAGE &Unsent>" METHOD="POST" ENCTYPE="multipart/form-data" NAME="Send" onSubmit="return passvalue( );">
<font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">
<div align="center">
<table cool width="722" height="579" usegridx usegridy showgridx
showgridy gridx="16" gridy="16" border="0" cellpadding="0" cellspacing="0" bgcolor="white">
<tr height="64">
<td width="16" height="578" rowspan="3"><spacer
type="block" width="16" height="626"></td>
<td style="font-size:18px" width="305" height="64" valign="bottom" align="left"
xpos="16" rowspan="2"><!-- <img src="/login/internet%20services/www/images/logo_3k.jpg" width="95"
height="43" border="0"> -->
<font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">
<label><b>Request For Secure
Account</font></b></label></td>
<td width="367" height="64" colspan="2" rowspan="2" align="left" xpos="256" content valign="top" csheight="96"
style="font-family:arail;font-size:14px;color:#008080">Welcome! Please fill out the form below ( <img src="/images/red.gif"
width="12" height="12" border="0" align="baseline">Fields are required).We will assign an account
to you that will allow you access to our resources. Please allow for a maximum of one
business day for account processing.</td>
<td width="33" height="64" rowspan="2"><spacer
type="block" width="33" height="112"></td>
<td width="1" height="64"><spacer type="block" width="1"
height="64"></td>
</tr>
<tr height="48">
<td width="1" height="1"><spacer type="block" width="1"
height="48"></td>
</tr>
<tr height="514">
<td width="352" height="514" colspan="2" valign="top"
align="left" xpos="16">
<table border="0" cellpadding="0"
cellspacing="2" width="348">
<tr>
<td style="font-size:13px;font-family:arial;color=#008080">
<TABLE BORDER=0
CELLSPACING=0 CELLPADDING=0>
<tr height="25">
<td
valign=top height="25" width="90" style="font-size:13px;font-family:arial;color=#008080"> </td>
<td
valign=bottom height="25" width="245" color="#008080 "> </td>
</tr>
<tr height="25">
<td valign=top height="25" width="90" style="font-size:13px;font-family:arial;color=#008080">First name: </td>
<td
valign=bottom height="25" width="245" color="#008080 "><input class=formfield type="text" size=29 maxlength=1000
name="FIELDID:1007=STRING" value="<X-FC-FIELD 1007 STRING>" tabindex="1" onFocus='nextfield=1'><img
src="/images/red.gif" width="12" height="12" border="0" align="absmiddle"></td>
</tr>
<tr height="25">
<td
valign=top height="25" width="90" style="font-size:13px;font-family:arial;color=#008080">Last name:</td>
<td
valign=top height="25" width="245"><input class=formfield type="text" size=29 maxlength=1000
name="FIELDID:1009=STRING" value="<X-FC-FIELD 1009 STRING>" tabindex="2" onFocus='nextfield=2'><img
src="/images/red.gif" width="12" height="12" border="0" align="absmiddle"></td>
</tr>
<tr height="25">
<td
valign=top width="90" height="25" style="font-size:13px;font-family:arial;color=#008080">Telephone: </td>
<td
valign=top width="245" height="25"><input class=formfield type="text" size=29 maxlength=1000
name="FIELDID:1025=STRING" value="<X-FC-FIELD 1025 STRING>" tabindex="3" onFocus='nextfield=3'></td>
</tr>
<tr height="25">
<td
valign=top width="90" height="25" style="font-size:13px;font-family:arial;color=#008080">Fax: </td>
<td
valign=top width="245" height="25"><input class=formfield type="text" size=29 maxlength=1000
name="FIELDID:1027=STRING" value="<X-FC-FIELD 1027 STRING>" tabindex="4" onFocus='nextfield=4'></td>
</tr>
<tr height="25">
<td
valign=top width="90" height="25" style="font-size:13px;font-family:arial;color=#008080">email:</td>
<td
valign=top width="245" height="25"><input class=formfield type="text" size=29 maxlength=1000
name="FIELDID:1037=STRING" value="<X-FC-FIELD 1037 STRING>" tabindex="5" onBlur="
check(this.value);" onFocus='nextfield=5'><img src="/images/red.gif" width="12" height="12" border="0"
align="absmiddle"></td>
</tr>
<tr height="25">
<td
valign=top width="90" height="25" style="font-size:13px;font-family:arial;color=#008080">Company: </td>
<td
valign=top width="245" height="25"><input class=formfield type="text" name="FIELDID:1013=STRING" size="32"
value="<X-FC-FIELD 1013 STRING>" tabindex="6" onFocus='nextfield=6'><img src="/images/red.gif" width="12" height="12" border="0"
align="absmiddle"></td>
</tr>
<tr height="25">
<td
valign=top width="90" height="25" style="font-size:13px;font-family:arial;color=#008080">State/Province:</td>
<td
valign=top width="245" height="25"><input class=formfield type="text" size=21 maxlength=1000
name="FIELDID:1019=STRING" value="<X-FC-FIELD 1019 STRING>" tabindex="7" onFocus='nextfield=7'></td>
</tr>
<tr height="25">
<td
valign=top width="90" height="25" style="font-size:13px;font-family:arial;color=#008080">Street: </td>
<td
valign=top width="245" height="25"><input class=formfield type="text" size=21 maxlength=1000
name="FIELDID:1015=STRING" value="<X-FC-FIELD 1015 STRING>" tabindex="8" onFocus='nextfield=8'></td>
</tr>
<tr height="25">
<td
valign=top width="90" height="25" style="font-size:13px;font-family:arial;color=#008080">City/Town:</td>
<td
valign=top width="245" height="25"><input class=formfield type="text" size=21 maxlength=1000
name="FIELDID:1017=STRING" value="<X-FC-FIELD 1017 STRING>" tabindex="9" onFocus='nextfield=9'></td>
</tr>
<tr height="25">
<td
valign=top width="90" height="25" style="font-size:13px;font-family:arial;color=#008080">ZIP/Postal :</td>
<td
valign=top width="245" height="25"><input class=formfield type="text" size=21 maxlength=1000
name="FIELDID:1023=STRING" value="<X-FC-FIELD 1023 STRING>" tabindex="10" onFocus='nextfield=10'></td>
</tr>
<tr height="25">
<td
valign=top width="90" height="25" style="font-size:13px;font-family:arial;color=#008080">Country:</td>
<td
valign=top width="245" height="25" ><input class=formfield type="text" size=21 maxlength=1000
name="FIELDID:1021=STRING" value="<X-FC-FIELD 1021 STRING>" tabindex="11" onFocus='nextfield=11'></td>
</tr>
</table>
</td>
</tr>
</table>
</td>
<td width="353" height="514" colspan="2" valign="top"
align="left" xpos="368">
<table border="0" cellpadding="0"
cellspacing="2" width="324" height="283">
<tr>
<td colspan="3" style="font-size:13px;font-family:arial;color=#008080" height="24">Comments:</td>
</tr>
<tr>
<td colspan="3" height="52">
<p>
<textarea
name="FIELDID:1033=LITERALSTRING" cols="40" rows="5" tabindex='12' onFocus='nextfield=23'><x-fc-field 1033
literalstring></textarea></p>
</td>
</tr>
<tr>
<td colspan="3" height="42" >
<div align="center" style="font-size:11px;font-family:arial;color=#008080; width:340; height:42">
<b>You may request a userID below however, we
may have to change it when setting up your
account. Your password will be set up as
requested so make sure to remember it!</b></div>
</td>
</tr>
<tr>
<td colspan="3" height="157">
<div align="center">
<fieldset>
<input type="hidden" name="FIELDID:2038=STRING" size="32" value='<!--#echo var="DATE_LOCAL"-->'>
<input type="hidden" name="FIELDID:2039=STRING" size="23" value='<!--#echo
var="HTTP_REFERER"-->'>
<input type="hidden" name="FIELDID:2040=STRING" size="32" value='<!--#echo var="HTTP_HOST"-->'>
<input type="hidden" name="FIELDID:2041=STRING" size="24" value='<!--#echo
var="REMOTE_PORT"-->'>
<input type="hidden" name="FIELDID:2042=STRING" size="32" value='<!--#echo
var="REMOTE_HOST"-->'>
<input type="hidden" name="FIELDID:2043=STRING" size="24" value='<!--#echo
var="REMOTE_ADDR"-->'>
<input type="hidden" name="FIELDID:2044=STRING" size="32" value='<!--#echo
var="REMOTE_IDENT"-->'>
<input type="hidden" name="FIELDID:2045=STRING" size="24" value='<!--#echo
var="HTTP_USER_AGENT"-->'>
<input type="hidden" value="Administrator" name="TO=LITERALSTRING">
<input type="hidden" name="From=LITERALSTRING" value="<X-FC-USER-NAME>">
<legend style="font-size:13px;font-family:arial;color=#008080">Requested:</legend>
<table border="0" cellpadding="0" cellspacing="2" width="288" height="94">
<tr height="23">
<td colspan="2" height="23" style="font-size:13px;font-family:arial;color=#008080">UserID:</td>
<td height="23" width="201"><INPUT class=formfield TYPE="text" SIZE=22 MAXLENGTH=1000 NAME="FIELDID:1029=STRING"
VALUE="<X-FC-FIELD 1029 STRING>" tabindex="13" onFocus='nextfield=24'></td>
</tr>
<tr height="23">
<td colspan="2" height="23" style="font-size:13px;font-family:arial;color=#008080">Password:</td>
<td height="23" width="201" ><input class=formfield type="password" size=22 maxlength=12
name="FIELDID:1031=STRING" value="<X-FC-FIELD 1031 STRING>" tabindex="14" onFocus='nextfield="Send"'>
<img src="/images/red.gif" width="12" height="12" border="0" align="absmiddle"></td>
</tr>
<tr>
<td colspan="3" style="font-size:11px;font-family:arial;color=#008080"><b>After
completing this form, click the Send button we will process your account and
send your confirmed user ID to the email address supplied. Note: We will not
send your password by email .</b></font></td>
</tr>
</table>
</fieldset>
<input type="submit" name="Send" value="Send"
tabindex="15" >
<!--
<input type="button" name="Cancel" value="Cancel"
tabindex="15" onClick="doDelete();" onFocus='nextfield="0"'>
-->
<input type="button" name="Cancel" value="Cancel"
tabindex="16" onClick="history.go(-1);" onFocus='nextfield="0"'>
<script language='javascript'>
function doDelete() {
window.location.href="<X-FC-OBJURL>?Delete=1&close=1"
}
</script>
</div>
</td>
</tr>
</table>
</font>
</form>
</td>
<td width="1" height="514"><spacer type="block"
width="1" height="514"></td>
</tr>
<tr height="1" cntrlrow>
<td width="16" height="1"><spacer type="block"
width="16" height="1"></td>
<td width="305" height="1"><spacer type="block"
width="240" height="1"></td>
<td width="47" height="1"><spacer type="block"
width="112" height="1"></td>
<td width="320" height="1"><spacer type="block"
width="320" height="1"></td>
<td width="33" height="1"><spacer type="block"
width="33" height="1"></td>
<td width="1" height="1"><spacer type="block" width="1"
height="1"></td>
</tr>
</table>
</div>
</td>
</tr>
</table>
<!-- end of table for send.1000 -->
</body>
</html>
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