{JAVASCRIPTFORM}


<table width="100%" cellspacing="0" cellpadding="4" border="0">
	<tr>
		<td><h1>Contact/Directions</h1></td>
		<!--<td align="right"><span style="font-size:11px;"><a href="contact_main.html">Get Directions</a></span>--></td>
	</tr>
</table>


<table width="100%" cellspacing="0" cellpadding="4" border="0">
<tr>


<!-- ---- contact form ------>
<td valign="top" width="65%">
<form action="http://datahost.com/form.php" name= "form" method="POST" onSubmit ="return check_required('form')">

<input type="Hidden" name="receiver_list" value="{CODED_EMAIL}">
       
<input type="Hidden" name="response_location" value="{RELATIVEURL}/home/{SESSION}/thankyou_main.html">
       
<input type="Hidden" name="required" value="Email_Address,Comments">
       
<input type="Hidden" name="email_subject" value="{store_name} Inquiry">
<input type="Hidden" name="source" value="{SOURCE}">
		
		
		<table width="100%" cellspacing="0" cellpadding="4" border="0">
			
			<tr valign="top">
				<td align="right" width="30%">Name:</td> 
				<td align="left" width="70%"><input type=text name="Name" size="30"></td>
			</tr>
			<tr valign="top">
				<td align="right">Farm/Ranch:</td>
 				<td align="left"><input type=text name="Company" size="30"></td>
			</tr>
			<tr valign="top">
				<td align="right">Email:</td>
				<td align="left"><input type=text name="Email_Address" size="30" maxlength="100"></td>
			</tr>
			<tr valign="top">
				<td align="right">Phone:</td>
				<td align="left"><input type=text name="Phone" size="30"></td>
			</tr>
			<tr valign="top">
				<td align="right">Preferred Contact Method:</td>
				<td align="left"><input type=radio name="ReturnBy" value="Email">Email &nbsp;  &nbsp; <input type=radio name="ReturnBy" value="Phone">Phone</td>
			</tr>

			<tr valign="top">
				<td align="right">Where did you hear about us?</td>
				<td align="left"><input type=text name="Source" size="30"></td>
			</tr>
			
			
			<tr valign="top">
				<td align="right">Your Questions or Comments:</td>
				<td align="left"><textarea name="Comments" cols="20" rows="4" wrap="VIRTUAL"></textarea></td>
			</tr>
			
			<tr valign="top">
				<td align="right"></td>
				<td align="left"><input type="Submit" name="submit" class="fancybutton" value="Send"><p></td>
			</tr>
		</table></form>
		
<a href="maps.html" target="_blank"><img src="images/michigan2.jpg" border="0" alt=""></a>
</td>


<!-- ---- contact data ------>
	<td valign="top" width="35%">
	
		<table cellpadding="0" cellspacing="0" width="190" border="0">
			<tr><td><img src="images/contact-box-top.jpg" border="0" alt=""></td></tr>
		
			<tr>
				<td style="background-color:#aa9987; border-left:2px solid #5c1f03;border-right:2px solid #5c1f03;">
					<div style="padding:10px;">
					
						<div class="contactsidebar" style="position:relative;top:-16px;">{global_blurb2}</div>
						
						<!--<div><p class="contactsidebar"><a href="javascript:void(0)" onclick="window.open('{BASEURL}/home/{STOREID}/maps.html','newin','toolbar=no,location=no,directories=0,status=0,resizable=yes,menubar=no,scrollbars=yes,width=820,height=700')">Click for Maps/Directions</a></p>-->

						<p class="contactsidebar"><a href="maps.html" target="_blank">Click for Maps/Directions</a></p>
						<br>

						
                        <!--insert|product|120||<a href="maps.html" target="_blank"><img src="<<th_product_image3>>" border="1" width="160" alt=""></a>||-->
<br><br>
                      

                        </div>
						
					</div>
			
				</td>
			</tr>
		
			<tr><td><img src="images/contact-box-bottom.jpg" border="0" alt=""></td></tr>
		</table>
	</td>


</tr>
</table>
<!--/contact_main.html-->