<![CDATA[
<body bgcolor="#000000" leftmargin="0" topmargin="0" marginwidth="0" marginheight="0">
<p><img src="../images/dot_clear.gif" width="329" height="44"></p>
<form name="contactForm" method="Post" action="/cgi-bin/cgiemail/contact/guest.txt">
<table border="0" cellspacing="0" cellpadding="0" width="600">
<tr valign="top">
<td align="right" width="48"><img src="../images/dot_clear.gif" width="16" height="1" border="0"><img src="../images/initial_bracket.gif" width="32" height="45"></td>
<td>
<p><img src="../images/initial_write.gif" width="66" height="19" align="bottom">,
call or fax or sign our guestbook below. We look forward to hearing from
you.<br>
<br>
</p>
<p></p>
<p></p>
<p>
<input name="position" type="radio" value="Mr.">
Mr.
<input name="position" type="radio" value="Ms.">
Ms.
<input name="position" type="radio" value="Dr.">
Dr.<br>
</p>
<p> Name<br>
<input name="required-realname" type="text" size=30,1 maxlength=57>
</p>
<p> Title<br>
<input name="title" type="text" size=30,1 maxlength=57>
</p>
<p> Company<br>
<input name="company" type="text" size=30,1 maxlength=57>
<br>
</p>
<p>Email<br>
<input name="required-email" type="text" size=30,1 maxlength=57>
</p>
</td>
<td><img src="../images/dot_clear.gif" width="16" height="16" border="0"></td>
<td background="../images/dottedline_v.gif"><img src="../images/dot_clear.gif" width="1" height="16" border="0"></td>
<td><img src="../images/dot_clear.gif" width="16" height="16" border="0"></td>
<td>
<p>Address<br>
<input name="address" type="text" size=30,1 maxlength=57>
</p>
<p> City<br>
<input name="city" type="text" size=20,1 maxlength=50>
</p>
<p>
<table cellspacing="0" cellpadding="0" border="0">
<tr>
<td>
<p>State<br>
<input name="state" type="text" size=2,1 maxlength=25>
</p>
</td>
<td><img src="../images/dot_clear.gif" width="12" height="24" border="0"></td>
<td>
<p>Zip<br>
<input name="zip" type="text" size=10,1 maxlength=10>
</p>
</td>
<td><img src="../images/dot_clear.gif" width="12" height="24" border="0">
</td>
<td>
<p>Telephone<br>
<input name="phone" type="text" size=10,1 maxlength=20>
</p>
</td>
</tr>
</table><br>
<p>Would you like an account representative to call?<br>
<input name="call" type="radio" value="yes">
yes
<input name="call" type="radio" value="no">
no </p>
<p>Comments<br>
<textarea name="comments" rows=4 cols=30 wrap=VIRTUAL></textarea>
</p>
<p>
<input type="hidden" name="success" value="http://www.futuremediainc.com/contact/success.html">
<input type="image" alt="submit" name="submit" src="images/submit.gif" width="79" height="23" border="0" value="submit">
<!-- Çinput type="image" alt="reset" name="reset" src="images/reset.gif" width="79" height="23" border="0" value="reset" onclick="document.forms['contactForm'].reset();È -->
</p>
</td>
<td><img src="../images/dot_clear.gif" width="32" height="16" border="0"></td>
<td><img src="images/contactinfo.gif" width="106" height="180" border="0"></td>
</tr>
</table>
</form>
</body>
]]>