<!-- BOF: ./personal-templates/show.body -->
<!-- BOF: ./personal-templates/simple/generic/show -->
<!-- BOF: ./personal-templates/rtl.html -->

    
<!-- Locale=en_US_ISO8859_1 -->

    
<!-- EOF: ./personal-templates/rtl.html -->


<!-- BOF: ./personal-templates/simple/generic/functions -->
<!-- BOF: ./personal-templates/simple/generic/navbar --><!-- EOF: ./personal-templates/simple/generic/navbar -->


<!-- EOF: ./personal-templates/simple/generic/functions -->


<!-- EOF: ./personal-templates/simple/generic/show -->

<!-- BOF: ./personal-templates/simple/generic/images -->

<!-- EOF: ./personal-templates/simple/generic/images -->


<!-- BOF: ./personal-templates/simple/personal/other/l59.settings.init -->


<!-- EOF: ./personal-templates/simple/personal/other/l59.settings.init -->


    <!-- BOF: ./personal-templates/simple/businessnew/amazon/style_l59.images -->

<!-- EOF: ./personal-templates/simple/businessnew/amazon/style_l59.images -->

    <!-- BOF: ./personal-templates/simple/businessnew/amazon/style_l59.wait -->

 
<!-- EOF: ./personal-templates/simple/businessnew/amazon/style_l59.wait -->

  
  <!-- BOF: ./personal-templates/simple/business/layout/l59.wait -->


<!-- EOF: ./personal-templates/simple/business/layout/l59.wait -->


<HTML>

<HEAD>


<META NAME="description" CONTENT="">
<META NAME="Keywords"    CONTENT="">


<!-- business -->


<META HTTP-EQUIV="Content-Type" CONTENT="text/html; charset=UTF-8">
<META NAME="Generator" content="">
<!-- BOF: ./personal-templates/simple/themes.show -->


<!-- EOF: ./personal-templates/simple/themes.show -->


<!--<BASE HREF="http://d2318815.u21.hosting-advantage.com/form2.html">-->
<TITLE>NCOA Request</TITLE></head>
<BODY  BGCOLOR="#FFFFFF"
 TEXT="#CC3300"

LEFTMARGIN="0" TOPMARGIN="0" RIGHTMARGIN="0" BOTTOMMARGIN="0"

 onLoad=""
 
 LINK="#000000"
 VLINK="#666666"
 ALINK="#000000"
>

  
      <!-- BOF: ./personal-templates/simple/business/layout/l59.layout -->

 
<!-- html -->
<TABLE WIDTH="100%" height="100%" BORDER=0 CELLPADDING=0 CELLSPACING=0 align="center" valign="top" background="widgets/gen_360.1.gif" bgcolor="#9A9999">
    <TR>
       <TD align="center" valign="top" background="">
            <TABLE WIDTH="90%" BORDER=0 CELLPADDING=0 CELLSPACING=10 align="center" valign="top">
              <tr>
                <td width="100%" colspan="2">
                    <TABLE height="76" WIDTH="100%" BORDER=0 CELLPADDING=0 CELLSPACING=0 valign="top">
                       <tr>
                         <td width="687" height="76"><img src="widgets/gen_387.1.gif" border=0 width=687 height=76 alt=""></td>
                         <td background="widgets/gen_345.1.gif">&nbsp;</td>
                         <td width="14" height="76" align="right"><img src="widgets/gen_346.1.gif" border=0 width=14 height=76 alt=""></td>
                       </tr>
                    </table>
                </td>
              </tr>
              <tr>
                <td width="206" height="100%" valign="top">
                <TABLE WIDTH="206" height="100%" BORDER=0 CELLPADDING=0 CELLSPACING=0 valign="top">
                    <tr><td valign="top">
                      <TABLE WIDTH="206" BORDER=0 CELLPADDING=0 CELLSPACING=0 valign="top">
                         <tr>
                           <td colspan="3"><img src="widgets/gen_365.1.gif" border=0 width=206 height=31 alt=""></td>
                         </tr>
                         <tr>
                           <td width="13" background="widgets/gen_368.1.gif"><img src="images/spacer.png" width="13" height="1"></td>
                           <td bgcolor="#E7E4E4" valign="top">
                                            
                                            
                                            <a href="index.html" onMouseOver="document.images['img6'].src='widgets/gen_401.1.gif'" onMouseOut="document.images['img6'].src='widgets/gen_400.1.gif'"><img src="widgets/gen_400.1.gif" alt="Welcome" name="img6" border="0"></a><br>
                                            <a href="form.html" onMouseOver="document.images['img9'].src='widgets/gen_375.1.gif'" onMouseOut="document.images['img9'].src='widgets/gen_374.1.gif'"><img src="widgets/gen_374.1.gif" alt="POSTAGE REQUEST" name="img9" border="0"></a><br>
                                            <a href="form.html1.html" onMouseOver="document.images['img22'].src='widgets/gen_377.1.gif'" onMouseOut="document.images['img22'].src='widgets/gen_376.1.gif'"><img src="widgets/gen_376.1.gif" alt="PRINTING QUOTE REQUEST" name="img22" border="0"></a><br>
                                            <a href="form1.html" onMouseOver="document.images['img34'].src='widgets/gen_379.1.gif'" onMouseOut="document.images['img34'].src='widgets/gen_378.1.gif'"><img src="widgets/gen_378.1.gif" alt="MAILING QUOTE REQUEST" name="img34" border="0"></a><br>
                                            <a href="form2.html" onMouseOver="document.images['img42'].src='widgets/gen_416.1.gif'" onMouseOut="document.images['img42'].src='widgets/gen_415.1.gif'"><img src="widgets/gen_415.1.gif" alt="NCOA REQUEST" name="img42" border="0"></a><br>
                                            <a href="links.html" onMouseOver="document.images['img63'].src='widgets/gen_414.1.gif'" onMouseOut="document.images['img63'].src='widgets/gen_413.1.gif'"><img src="widgets/gen_413.1.gif" alt="Internet Links for Reference" name="img63" border="0"></a><br>
                                            <a href="Download.html" onMouseOver="document.images['img78'].src='widgets/gen_410.1.gif'" onMouseOut="document.images['img78'].src='widgets/gen_409.1.gif'"><img src="widgets/gen_409.1.gif" alt="PDF FORMS" name="img78" border="0"></a><br><a href="mailto:firstclass@mikelmailings.com" onMouseOver="document.images['img_email'].src='widgets/gen_385.1.gif'" onMouseOut="document.images['img_email'].src='widgets/gen_384.1.gif'"><img src="widgets/gen_384.1.gif" alt="e-mail me" name="img_email" border="0"></a><br>
                                            </td>
                           <td width="13" background="widgets/gen_367.1.gif"><img src="images/spacer.png" width="13" height="1"></td>
                         </tr>
                         <tr>
                           <td colspan="3"><img src="widgets/gen_366.1.gif" border=0 width=206 height=17 alt=""></td>
                         </tr>
                      </table>
                      </td></tr>
                      <tr><td><img src="widgets/spacer.gif" height=5 width=20 alt=""></td></tr>
                      <tr>
                      <td WIDTH="206" height="100%">
                      <TABLE WIDTH="206" height="100%" BORDER=0 CELLPADDING=0 CELLSPACING=0 valign="top">
                          <tr>
                             <td width="206" height="12"><img src="widgets/gen_369.1.gif" border=0 width=206 height=12 alt=""></td>
                          </tr>
                          <tr>
                             <td height="100%" background="widgets/gen_371.1.gif" height="100%">&nbsp;</td>
                          </tr>
                          <tr>
                             <td width="206" height="12" valign="bottom"><img src="widgets/gen_370.1.gif" border=0 width=206 height=12 alt=""></td>
                          </tr>
                      </table>
                      </td></tr></table>
                </td>
                <td height="100%" width="100%" valign="top">
                <TABLE DIR="LTR" WIDTH="100%" height="100%" BORDER=0 CELLPADDING=0 CELLSPACING=0 valign="top">
                          <TR>
                              <td colspan="3" width="100%">
                              <TABLE WIDTH="100%" height="30" BORDER=0 CELLPADDING=0 CELLSPACING=0 valign="top">
                                <tr>
                                  <td width="478" height="30"><img src="widgets/gen_402.1.gif" border=0 width=478 height=30 alt=""></td>
                                  <td width="100%" background="widgets/gen_341.1.gif"><img src="widgets/spacer.gif" height=30 width=1 alt=""></td>
                                  <td width="11"><img src="widgets/gen_342.1.gif" border=0 width=11 height=30 alt=""></td>
                                </tr>
                              </table>
                              </td>
                          </TR>
                          <tr><td colspan="3" height="10"><img src="widgets/spacer.gif" height=10 width=11 alt=""></td></tr>
                          <tr>
                             <td width="11" height="10"><img src="widgets/gen_361.1.gif" border=0 width=11 height=10 alt=""></td>
                             <td height="10" width="100%" background="widgets/gen_357.1.gif"></td>
                             <td width="11" height="10"><img src="widgets/gen_362.1.gif" border=0 width=11 height=10 alt=""></td>
                          </tr>
                          <tr>
                             <td height="100%" width="11" background="widgets/gen_358.1.gif"><img src="widgets/spacer.gif" height=1 width=11 alt=""></td>
                             <TD width="100%" height="100%" bgcolor="#CCCCCC" valign="top">
                             <!-- BOF: ./personal-templates/simple/businessnew/form/style_l59.html -->
<TABLE WIDTH=100% BORDER=0 CELLPADDING=0 CELLSPACING=0 VALIGN="top">
<TR>
    <TD WIDTH=100% COLSPAN="2" VALIGN="top">
       <TABLE WIDTH=100% BORDER=0 CELLPADDING=0 CELLSPACING=0 VALIGN="top">
         <TR>
<SCRIPT LANGUAGE="JavaScript">
function validate(frm){
var i = 0;

if (frm.field_46.value=="") return error(frm.field_46);

if (frm.field_47.value=="") return error(frm.field_47);

if (frm.field_48.value=="") return error(frm.field_48);

if (frm.field_49.value=="") return error(frm.field_49);

if (frm.field_50.value=="") return error(frm.field_50);

if (frm.field_51.value=="") return error(frm.field_51);

return true;
}
function error(field){ alert('You did not fill all required fields!'); field.focus(); return false; }
</SCRIPT>
<form name="questionary" action="http://cp.hosting-advantage.com/studio/servlet/psoft.customform.CustomForm" method="post">
<input type="hidden" name="domain" value="">
<input type="hidden" name="title" value="NCOA Request">
<input type="hidden" name="efrom" value="">
<input type="hidden" name="email" value="firstclass@mikelmailings.com">
<input type="hidden" name="esubj" value="NCOA request">
<input type="hidden" name="submit_url" value="onsubmit3.html">
<input type="hidden" name="error_url"  value="onerror3.html">
<input type="hidden" name="order" value="82 46 47 48 49 50 51 52 53 ">
<script>
var p = location.pathname;
if (p.charAt(p.length)!='/') {
    p = p.substring(0, p.lastIndexOf('/')+1);
}
document.forms[0].domain.value = location.protocol+'//'+location.host+p;
</script>
        <TD VALIGN="top">
        
<TABLE WIDTH=100% BORDER=0 CELLPADDING=0 CELLSPACING=0 VALIGN="top">
                                 <TR>
                                    <TD WIDTH=6 HEIGHT=7>
                                        <img src="widgets/gen_331.1.gif" border=0 width=6 height=7 alt=""></TD>
                                    <TD background="widgets/gen_330.1.gif">
                                        <img src="widgets/spacer.gif" height=1 width=7 alt=""></TD>
                                    <TD ALIGN="right" WIDTH=5 HEIGHT=7>
                                        <img src="widgets/gen_332.1.gif" border=0 width=5 height=7 alt=""></TD>
                                 </TR>
                                 <TR>
                                    <TD background="widgets/gen_334.1.gif">
                                        <img src="widgets/spacer.gif" height=5 width=6 alt=""></TD>
                                    <TD WIDTH=100% VALIGN="top" BGCOLOR="#E7E4E4" VALIGN="top" style='border-bottom: 1px dotted #9A9999'>

         <span style="color:#81718E;font-size:12px;font-weight:bold;font-family:Verdana,Arial,Helvetica">NCOA Request</span>
         </TD>
         <TD background="widgets/gen_333.1.gif"><img src="widgets/spacer.gif" height=5 width=5 alt=""></TD>
         </TR>
         <TR>
                <TD background="widgets/gen_335.1.gif"><img src="widgets/spacer.gif" height=1 width=6 alt=""></TD>
                <TD WIDTH=100% VALIGN="top" BGCOLOR="#FFFFFF" VALIGN="top">                         
                 
        <TABLE border="0" cellpadding="5" cellspacing="5" width="100%">
        <input type="hidden" name="name_82" value="All questions marked with an * are required. (ALL INFO PROVIDED IS CONFIDENTIAL)">
        <TR><TD>


<font face='Arial' size='2' color='#CC3300'>

All questions marked with an * are required. (ALL INFO PROVIDED IS CONFIDENTIAL)

</font>


</td>
            <TD><input type="text" name="field_82" size=35 style="background: #CCCCCC;border:1px solid #9A9999">
            
            </TD>
        </TR>
        <input type="hidden" name="name_46" value="*1. COMPANY NAME responsible for mail list?">
        <TR><TD>


<font face='Arial' size='2' color='#CC3300'>

*1. COMPANY NAME responsible for mail list?

</font>


<font color="red" size="-1">*</font></td>
            <TD><input type="text" name="field_46" size=35 style="background: #CCCCCC;border:1px solid #9A9999">
            
            </TD>
        </TR>
        <input type="hidden" name="name_47" value="*2. Company ADDRESS?">
        <TR><TD>


<font face='Arial' size='2' color='#CC3300'>

*2. Company ADDRESS?

</font>


<font color="red" size="-1">*</font></td>
            <TD><textarea name="field_47" rows="5" cols="30" style="background: #CCCCCC;border:1px solid #9A9999"></textarea>
            
            </TD>
        </TR>
        <input type="hidden" name="name_48" value="*3. Company PHONE #?">
        <TR><TD>


<font face='Arial' size='2' color='#CC3300'>

*3. Company PHONE #?

</font>


<font color="red" size="-1">*</font></td>
            <TD><input type="text" name="field_48" size=35 style="background: #CCCCCC;border:1px solid #9A9999">
            
            </TD>
        </TR>
        <input type="hidden" name="name_49" value="*4. Contact NAME?">
        <TR><TD>


<font face='Arial' size='2' color='#CC3300'>

*4. Contact NAME?

</font>


<font color="red" size="-1">*</font></td>
            <TD><input type="text" name="field_49" size=35 style="background: #CCCCCC;border:1px solid #9A9999">
            
            </TD>
        </TR>
        <input type="hidden" name="name_50" value="*5. Contact TITLE?">
        <TR><TD>


<font face='Arial' size='2' color='#CC3300'>

*5. Contact TITLE?

</font>


<font color="red" size="-1">*</font></td>
            <TD><input type="text" name="field_50" size=35 style="background: #CCCCCC;border:1px solid #9A9999">
            
            </TD>
        </TR>
        <input type="hidden" name="name_51" value="*6. Contact E-MAIL?">
        <TR><TD>


<font face='Arial' size='2' color='#CC3300'>

*6. Contact E-MAIL?

</font>


<font color="red" size="-1">*</font></td>
            <TD><input type="text" name="field_51" size=35 style="background: #CCCCCC;border:1px solid #9A9999"><input type="hidden" name="rcpt" value="field_51">
            
            </TD>
        </TR>
        <input type="hidden" name="name_52" value="7. NAICS #?">
        <TR><TD>


<font face='Arial' size='2' color='#CC3300'>

7. NAICS #?

</font>


</td>
            <TD><input type="text" name="field_52" size=35 style="background: #CCCCCC;border:1px solid #9A9999">
            
            </TD>
        </TR>
        <input type="hidden" name="name_53" value="Search for the NAIC # from the Internet Links section. Need some HELP?">
        <TR><TD>


<font face='Arial' size='2' color='#CC3300'>

Search for the NAIC # from the Internet Links section. Need some HELP?

</font>


</td>
            <TD><input type="radio" name="field_53" value="Yes">


<font face='Arial' size='2' color='#CC3300'>

Yes

</font>


 <input type="radio" name="field_53" value="No">


<font face='Arial' size='2' color='#CC3300'>

No

</font>


            </TD>
        </TR>
        
        <TR><TD colspan=2 align=center><input onClick="return validate(form)" type="submit" value="Submit" style="background: #E7E4E4;border:1px solid #9A9999">
            <input type="reset"  value="Reset" style="background: #E7E4E4;border:1px solid #9A9999"></TD>
        </TR>
        </TABLE>
        
                                    </TD>
                                    <TD background="widgets/gen_336.1.gif">
                                        <img src="widgets/spacer.gif" height=1 width=5 alt=""></TD>
                                 </TR>
                                 <TR>
                                    <TD WIDTH=6 HEIGHT=8>
                                        <img src="widgets/gen_337.1.gif" border=0 width=6 height=8 alt=""></TD>
                                    <TD background="widgets/gen_339.1.gif">
                                        <img src="widgets/spacer.gif" height=1 width=6 alt=""></TD>
                                    <TD WIDTH=5 HEIGHT=8>
                                        <img src="widgets/gen_338.1.gif" border=0 width=5 height=8 alt=""></TD>
                                 </TR>
                                 <TR> 
                                    <TD COLSPAN=3>
                                        <img src="widgets/spacer.gif" height=10 width=10 alt=""></TD>
                                 </TR>
                                        
                         </TABLE>
</form> 
    </TR>
    </TABLE>
    </TD>
</TR>
</TABLE>
<!-- EOF: ./personal-templates/simple/businessnew/form/style_l59.html -->

                                </td>
                             <td height="100%" width="11" background="widgets/gen_359.1.gif" align="right"><img src="widgets/spacer.gif" height=1 width=11 alt=""></td>
                          </tr>
                          <tr>
                             <td width="11" height="10"><img src="widgets/gen_364.1.gif" border=0 width=11 height=10 alt=""></td>
                             <td height="10" width="100%" background="widgets/gen_356.1.gif"></td>
                             <td width="11" height="10"><img src="widgets/gen_363.1.gif" border=0 width=11 height=10 alt=""></td>
                          </tr>
                       </table>
                </td></tr>
              <tr>
                 <td width="100%" colspan="2">
                      <TABLE DIR="LTR" WIDTH="100%" BORDER=0 CELLPADDING=0 CELLSPACING=0 valign="top">
                          <tr>
                             <td width="11" height="10"><img src="widgets/gen_349.1.gif" border=0 width=11 height=10 alt=""></td>
                             <td background="widgets/gen_351.1.gif" width="100%"></td>
                             <td width="16" height="10"><img src="widgets/gen_350.1.gif" border=0 width=16 height=10 alt=""></td>
                          </tr>
                          <tr>
                             <td background="widgets/gen_353.1.gif"><img src="widgets/spacer.gif" height=1 width=1 alt=""></td>
                             <TD bgcolor="#B5B4B4">
<center><table border="0" cellpadding="0" cellspacing="3"><tr><td align="center">

<a href="http://www.psoft.net" target="_blank"><img src="widgets/ss_button.gif" border="0"></a>

<br><font face="helvetica,verdana, arial" size="1">&nbsp;</font>

</td></tr></table></center>


<br>
<FONT FACE="verdana, arial, helvetica" SIZE="1">
<center>
<nobr>|<a href="index.html">Welcome</A>|</nobr>

<nobr>|<a href="form.html">POSTAGE REQUEST</A>|</nobr>

<nobr>|<a href="form.html1.html">PRINTING QUOTE REQUEST</A>|</nobr>

<nobr>|<a href="form1.html">MAILING QUOTE REQUEST</A>|</nobr>

<nobr>|NCOA REQUEST|</nobr>

<nobr>|<a href="links.html">Internet Links for Reference</A>|</nobr>

<nobr>|<a href="Download.html">PDF FORMS</A>|</nobr>
</center>
</font>

</td>
                             <td background="widgets/gen_354.1.gif"><img src="widgets/spacer.gif" height=1 width=1 alt=""></td>
                          </tr>
                          <tr>
                             <td><img src="widgets/gen_347.1.gif" border=0 width=11 height=15 alt=""></td>
                             <td background="widgets/gen_352.1.gif" width="100%"></td>
                             <td><img src="widgets/gen_348.1.gif" border=0 width=16 height=15 alt=""></td>
                          </tr>
                      </table>
                 </td>
              </tr>
            </TABLE>
       </TD>
    </TR>
</TABLE>
<!-- End html -->
<!-- EOF: ./personal-templates/simple/business/layout/l59.layout -->

    
<!-- BOF: ./personal-templates/simple/themes.show.body -->


<!-- EOF: ./personal-templates/simple/themes.show.body -->

</body>
<!-- BOF: ./personal-templates/simple/themes.show.end -->


<!-- EOF: ./personal-templates/simple/themes.show.end -->


</html>


<!-- EOF: ./personal-templates/show.body -->