Product Information/Contact Form

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=85 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <FONT SIZE="5" COLOR="#000000" FACE="Arial" ><B>Alpine Stove & Chimney Service</B></FONT><FONT SIZE="1" COLOR="#000000" FACE="Arial" ><B>     </B></FONT><B>|     </B><A HREF="index.htm" TARGET="_top" TITLE="Alpine Stove Chimney Service"><U><B>home</B></U></A></div> <div> <A HREF="id21.htm" TARGET="_top" TITLE="Retail Stores "><U>Retail Store's </U></A>   |   <A HREF="id63.htm" TARGET="_top" TITLE="Employment "><U>Employment </U></A>   |   <A HREF="id19.htm" TARGET="_top" TITLE="Location"><U>Location</U></A>   |   <A HREF="id44.htm" TARGET="_top" TITLE="Manufacturers Links"><U>Manufacturers Links</U></A>   |   <A HREF="id23.htm" TARGET="_top" TITLE="Products and Services"><U>Products and Services</U></A>   |   <B>Product Information/Contact Form</B>   |   <A HREF="id76.htm" TARGET="_top" TITLE="Service Evaluation Form"><U>Service Evaluation Form</U></A>   |   <A HREF="id18.htm" TARGET="_top" TITLE="Sales Items"><U>Sales Items</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=180 BGCOLOR="#990033" TEXT="#080000"> <div> <B>If you want information regarding any of our products on this web site or need to ask our customer service department a general question please submit a product information/contact request form stating what products your interested in.</B></div> <bR> </td> <td valign="top" height=395 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <I>Product Information/Contact Form</I></div> <DIV ALIGN="LEFT"></DIV> <div> <IMG SRC="245221f0.jpg" border=0 width="34" height="31" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></div> <bR> <bR> <div>  <form action="http://csbmail.globalscape.com/cgi-bin/csbmail/csbmail.pl" method="POST" enctype="application/x-www-form-urlencoded"><input type="hidden" name="tlx_SortOrder" value="FirstName,LastName,Email,Company,Address1,Address2,City,State,Zip,Phone,Fax,MailingList,Comments"><input type="hidden" name="tlx_FormIndex" value="2"><input type="hidden" name="tlx_OKMessage" value="Thank you for your request for information."><input type="hidden" name="tlx_SendMode" value="1"><input type="hidden" name="tlx_Subject" value="A request form was submitted"><input type="hidden" name="tlx_EmailTo" value="alpinestove@sbcglobal.net"> <table cellpadding="0" cellspacing="1" border="0" align="center"> <tr> <td align="left">First Name:<br> <input type="text" name="FirstName" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Last Name:<br> <input type="text" name="LastName" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Email:<br> <input type="text" name="Email" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Company:<br> <input type="text" name="Company" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Address Line 1:<br> <input type="text" name="Address1" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Address Line 2:<br> <input type="text" name="Address2" size="30" maxlength="100"></td> </tr> <tr> <td align="left">City:<br> <input type="text" name="City" size="30" maxlength="100"></td> </tr> <tr> <td align="left">State:<br> <input type="text" name="State" size="30" maxlength="100"></td> </tr> <tr> <td align="left">Zip:<br> <input type="text" name="Zip" size="10" maxlength="10"></td> </tr> <tr> <td align="left">Phone Number:<br> <input type="text" name="Phone" size="14" maxlength="14"></td> </tr> <tr> <td align="left">Fax Number:<br> <input type="text" name="Fax" size="14" maxlength="14"></td> </tr> <tr> <td> <input type="checkbox" name="MailingList" value="yes"> Add me to your mailing list</td> </tr> <tr> <td align="left">Comments:<br> <textarea name="Comments" rows="5" cols="30"></textarea></td> </tr> <tr> <td align="right"><input type="reset"> <input type="submit" value="Send" name="tlx_send"></td> </tr> </table> </form>  </div> <bR> </td> </tr></table></body>