echo "<table border=\"0\" cellpadding=\"0\" cellspacing=\"0\" width=\"100%\"> <tr> <td valign=\"top\" align=\"center\"> <table border=\"0\" cellpadding=\"9\" cellspacing=\"0\" width=\"95%\"><tr> <td><BLOCKQUOTE> <br><table width=\"80%\" border=\"0\" align=\"center\" cellpadding=\"2\" cellspacing=\"2\"><tr> <td colspan=\"5\"><div align=\"center\"><font size=\"2\" face=\"Arial, Helvetica, sans-serif\"><strong><font color=\"#000066\" size=\"6\">REMAX";
echo "</font><font size=\"4\"><br>ADVERTISING PROFORMER </font><br>(SINGLE MODULE) <font color=\"#FF0000\">ALL FIELDS MUST BE COMPLETED</font></strong></font> <font color=\"#FF0000\" size=\"2\" face=\"Arial, Helvetica, sans-serif\"><strong><br></strong></font><hr></div></td></tr><tr><td height=\"54\" colspan=\"5\"> <table width=\"60%\" border=\"0\" align=\"center\" cellpadding=\"2\" cellspacing=\"3\"><tr><td width=\"30%\" bgcolor=\"#CCCCCC\"><strong><font color=\"#000000\" size=\"2\" face=\"Arial, Helvetica, sans-serif\">";
echo "One Photo ONLY:</font></strong></td><td width=\"40%\" bgcolor=\"#CCCCCC\"><strong><font color=\"#000000\" size=\"2\" face=\"Arial, Helvetica, sans-serif\">Hard Copy Photo</font></strong></td><td width=\"5%\"> <strong><font size=\"2\" face=\"Arial, Helvetica, sans-serif\"><select name=\"hardcopy\" id=\"hardcopy\"><option value=\"n/a\">n/a</option><option value=\"Yes\">Yes</option><option value=\"No\">No</option></select></font></strong></td></tr><tr><td> </td><td bgcolor=\"#CCCCCC\"><strong><font size=\"2\" face=\"Arial, Helvetica, sans-serif\">Email Photo</font></strong></td><td><strong><font size=\"2\" face=\"Arial, Helvetica, sans-serif\"><select name=\"email\" id=\"email\"><option value=\"n/a\">n/a</option><option value=\"Yes\">Yes</option><option value=\"No\">No</option></select>";
echo " </font></strong></td></tr></table></td></tr><tr><td colspan=\"5\"><table width=\"100%\" border=\"0\" align=\"center\" cellpadding=\"2\" cellspacing=\"2\"><tr bgcolor=\"#CCCCCC\"><td width=\"62%\" height=\"26\"><strong><font color=\"#000000\" size=\"2\" face=\"Arial, Helvetica, sans-serif\">Headline<font size=\"1\">(28 Characters Max)</font></font></strong></td><td width=\"42%\"><strong><font color=\"#000000\" size=\"2\" face=\"Arial, Helvetica, sans-serif\">Suburb<font size=\"1\">(14 Characters Max)</font></font></strong></td></tr><tr><td><input name=\"headline\" type=\"text\" id=\"headline\" size=\"28\" maxlength=\"28\"></td><td><input name=\"suburb\" type=\"text\" id=\"suburb\" size=\"14\" maxlength=\"14\"></td></tr><tr> <td height=\"26\" colspan=\"2\" bgcolor=\"#CCCCCC\"><strong><font size=\"2\" face=\"Arial, Helvetica, sans-serif\">Body Text <font size=\"1\">(330 Characters Max)</font></font></strong></td>";
echo "</tr><tr> <td colspan=\"2\"><div align=\"center\"><textarea name=\"textarea\" cols=\"66\" rows=\"6\" wrap=\"VIRTUAL\" id=\"textarea\" onkeypress=\"LimitText(this,330)\" onkeyup=\"TrackCount(this,'textcount',330)\"></textarea><br><br><font color=\"#FF0000\" size=\"1\"><i><strong>Characters remaining:.. </strong></i></font></font> <font color=\"#FF0000\" size=\"1\" face=\"Arial, Helvetica, sans-serif\"><strong> <input name=\"textcount\" type=\"text\" value=\"330\" size=\"3\" maxlength=\"3\"></strong></font></p></div></td></tr></table></td></tr><tr align=\"center\" valign=\"middle\"> <td width=\"15%\" height=\"26\" valign=\"top\" bgcolor=\"#FFFFFF\"> <table width=\"100%\" border=\"0\" cellspacing=\"0\" cellpadding=\"0\"><tr><td height=\"26\" bgcolor=\"#CCCCCC\"><font size=\"2\" face=\"Arial, Helvetica, sans-serif\"><strong>INSPECT:</strong></font></td></tr><tr> <td height=\"26\" bgcolor=\"#FFFFFF\"> </td></tr>";
echo "</table><font size=\"2\" face=\"Arial, Helvetica, sans-serif\"> </font></td><td width=\"15%\" bgcolor=\"#FFFFFF\"> </td><td align=\"center\" valign=\"top\"><font size=\"2\" face=\"Arial, Helvetica, sans-serif\"><input name=\"inspect\" type=\"text\" id=\"inspect\" value=\"\" size=\"24\" maxlength=\"24\"></font></td><td width=\"15%\" align=\"center\" valign=\"top\" bgcolor=\"#FFFFFF\"> <table width=\"100%\" border=\"0\" cellspacing=\"0\" cellpadding=\"0\"><tr> <td height=\"26\" bgcolor=\"#CCCCCC\"><font size=\"2\" face=\"Arial, Helvetica, sans-serif\"><strong>PRICE:</strong></font></td>";
echo "</tr><tr> <td height=\"26\" bgcolor=\"#FFFFFF\"> </td></tr></table><font size=\"2\" face=\"Arial, Helvetica, sans-serif\"> </font></td><td align=\"center\" valign=\"top\"><font size=\"2\" face=\"Arial, Helvetica, sans-serif\"><input name=\"price\" type=\"text\" id=\"price\" size=\"18\" maxlength=\"18\"></font></td></tr><tr align=\"center\" valign=\"middle\"><td valign=\"top\"><table width=\"100%\" border=\"0\" cellspacing=\"0\" cellpadding=\"0\"><tr> <td height=\"26\" bgcolor=\"#CCCCCC\"><font size=\"2\" face=\"Arial, Helvetica, sans-serif\"><strong>ADDRESS:</strong></font></td></tr><tr> <td height=\"26\" bgcolor=\"#FFFFFF\"> </td></tr>";
echo "</table></td><td> </td><td align=\"center\" valign=\"top\"><font size=\"2\" face=\"Arial, Helvetica, sans-serif\"> <input name=\"address\" type=\"text\" id=\"address\" value=\"\" size=\"24\"><br><input name=\"address2\" type=\"text\" id=\"address2\" value=\"\" size=\"24\"></font></td><td align=\"center\" valign=\"top\" bgcolor=\"#FFFFFF\"> <table width=\"100%\" border=\"0\" cellspacing=\"0\" cellpadding=\"0\"><tr> <td height=\"26\" bgcolor=\"#CCCCCC\"><font size=\"2\" face=\"Arial, Helvetica, sans-serif\"><strong>CONTACT:</strong></font></td>";
echo "</tr><tr> <td height=\"26\" bgcolor=\"#FFFFFF\"> </td></tr></table><font size=\"2\" face=\"Arial, Helvetica, sans-serif\"> </font></td><td align=\"center\" valign=\"top\"><font size=\"2\" face=\"Arial, Helvetica, sans-serif\"> <textarea name=\"contact\" cols=\"18\" rows=\"2\" wrap=\"VIRTUAL\" id=\"contact\"></textarea></font></td></tr><tr> <td colspan=\"5\"><hr></td></tr><tr> <td colspan=\"5\"><div align=\"center\"><font color=\"#FF0000\" size=\"2\" face=\"Arial, Helvetica, sans-serif\"><strong>TO BE SUBMITTED TO SHIRLEY NOT LATER THAN 10AM TUESDAYS</strong></font></div></td>";
echo "</tr><tr> <td colspan=\"5\"><div align=\"center\"><table width=\"98%\" border=\"0\" cellspacing=\"0\" cellpadding=\"0\"><tr align=\"left\" valign=\"middle\"> <td width=\"40%\" height=\"62\"><strong><font color=\"#000000\" size=\"3\" face=\"Arial, Helvetica, sans-serif\">Image File:</font></strong></td><td> <div align=\"left\"><p> <font face=\"Arial, Helvetica, sans-serif\"> <input name=\"mainpic\" type=\"file\" id=\"mainpic\" size=\"60\"></font></p> </div></td></tr></table></div></td></tr></table></BLOCKQUOTE><div align=\"center\"><center><p><font face=\"Arial, Helvetica, sans-serif\">";
echo "<input name=\"submit\" type=\"submit\" value=\"Upload\"></font> </p><p><font face=\"Arial, Helvetica, sans-serif\"> <input name=\"Button\" type=\"button\" value=\"Complete\"></font></p><p><font face=\"Arial, Helvetica, sans-serif\"><input type=\"reset\" name=\"reset\" value=\"reset\"></font></p></center></div><HR></td></tr></table></td></tr></table>";
?>
</form>
</body>
</html>