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862 lines
19 KiB
HTML
862 lines
19 KiB
HTML
<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">
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<html>
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<body bgcolor="#ffffff" text="#000000" link="#0000ff" vlink=
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"#000099" alink="#000000">
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<table width="590" cellpadding="0" cellspacing="0" border="0">
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<tr>
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<td valign="top">
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<form>
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<table width="440" cellpadding="4" cellspacing="0"
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border="0" bgcolor="#99ccff">
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<tr>
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<td><font
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size="3"><b>Account Information</b></font></td>
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</tr>
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</table>
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<p></p>
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<table bgcolor="#ffcc66" border="0" cellpadding="0"
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cellspacing="0">
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<tr>
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<td align="right"><font size="2">
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First Name </font> </td>
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<td><input name="Name.First" size="20" maxlength="30"
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value=""></td>
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</tr>
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<tr>
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<td align="right"><font size="2">
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Last Name </font> </td>
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<td><input name="Name.Last" size="20" maxlength="30"
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value=""></td>
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</tr>
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<tr>
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<td align="right"><font size="2">
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Password </font> </td>
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<td><input name="f3" type="password" size="10"
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maxlength="10" value=""> <font size="2">
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(4 - 10 characters)</font></td>
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</tr>
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<tr>
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<td align="right"><font size="2">
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Retype Password </font> </td>
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<td><input name="RepeatPassword" type="password"
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size="10" maxlength="10" value=""></td>
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</tr>
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</table>
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<font size="2"><br>
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</font>
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<table width="440" cellpadding="4" cellspacing="0"
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border="0" bgcolor="#99ccff">
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<tr>
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<td><font
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size="3"><b>Shipping Information</b></font></td>
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</tr>
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</table>
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<table border="0">
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<tr>
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<td><font size=
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"2">Recipient Name</font></td>
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<td><input name="ShipTo.Name" size="24" maxlength="24"
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value=""></td>
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</tr>
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<tr>
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<td><font size=
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"2">Address Line 1</font></td>
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<td><input name="ShipTo.Street.Line1" size="29" maxlength="29"
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value=""></td>
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</tr>
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<tr>
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<td><font size=
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"2">Address Line 2</font></td>
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<td><input name="ShipTo.Street.Line2" size="29" maxlength="29"
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value=""></td>
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</tr>
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<tr>
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<td><font size=
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"2">City, State/Province</font></td>
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<td><input name="ShipTo.City" size="19" maxlength="25"
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value="">, <input name="ShipTo.State" size="8" maxlength="20"
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value=""></td>
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</tr>
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<tr>
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<td><font size=
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"2">ZIP/Postal Code</font></td>
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<td><input name="ShipTo.PostalCode" size="10" maxlength="10"
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value=""></td>
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</tr>
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<tr>
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<td><font size=
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"2">Country</font></td>
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<td><select name="ShipTo.Country" size="4">
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<option selected>
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USA
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</option>
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<option>
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Argentina
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</option>
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<option>
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Australia
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</option>
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<option>
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Austria
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</option>
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<option>
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Belgium
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</option>
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<option>
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Bermuda
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</option>
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<option>
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Brazil
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</option>
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<option>
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Canada
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</option>
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<option>
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Cayman Islands
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</option>
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<option>
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Chile
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</option>
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<option>
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China
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</option>
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<option>
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Colombia
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</option>
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<option>
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Corsica
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</option>
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<option>
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Costa Rica
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</option>
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<option>
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Croatia
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</option>
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<option>
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Cyprus
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</option>
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<option>
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Czech Republic
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</option>
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<option>
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Denmark
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</option>
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<option>
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Ecuador
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</option>
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<option>
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Egypt
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</option>
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<option>
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Estonia
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</option>
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<option>
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Fiji
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</option>
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<option>
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Finland
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</option>
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<option>
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France
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</option>
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<option>
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French Polynesia
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</option>
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<option>
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Germany
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</option>
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<option>
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Greece
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</option>
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<option>
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Grenada
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</option>
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<option>
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Hong Kong
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</option>
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<option>
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Hungary
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</option>
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<option>
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Iceland
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</option>
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<option>
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India
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</option>
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<option>
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Indonesia
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</option>
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<option>
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Ireland
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</option>
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<option>
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Israel
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</option>
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<option>
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Italy
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</option>
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<option>
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Japan
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</option>
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<option>
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Kuwait
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</option>
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<option>
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Latvia
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</option>
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<option>
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Lithuania
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</option>
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<option>
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Luxembourg
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</option>
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<option>
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Malaysia
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</option>
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<option>
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Malta
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</option>
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<option>
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Martinique
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</option>
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<option>
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Mauritius
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</option>
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<option>
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Mexico
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</option>
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<option>
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Netherlands
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</option>
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<option>
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Nether Antil
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</option>
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<option>
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New Caledonia
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</option>
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<option>
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New Zealand
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</option>
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<option>
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Norway
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</option>
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<option>
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Panama
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</option>
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<option>
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Paraguay
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</option>
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<option>
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Peru
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</option>
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<option>
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Philippines
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</option>
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<option>
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Poland
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</option>
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<option>
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Portugal
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</option>
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<option>
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Qatar
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</option>
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<option>
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Russia
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</option>
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<option>
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Saudi Arabia
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</option>
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<option>
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St Lucia
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</option>
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<option>
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Singapore
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</option>
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<option>
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Slovakia
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</option>
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<option>
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Slovenia
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</option>
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<option>
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South Africa
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</option>
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<option>
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South Korea
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</option>
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<option>
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Spain
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</option>
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<option>
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Sri Lanka
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</option>
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<option>
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Sweden
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</option>
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<option>
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Switzerland
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</option>
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<option>
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Syria
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</option>
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<option>
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Taiwan
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</option>
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<option>
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Thailand
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</option>
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<option>
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Trinidad & Toba
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</option>
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<option>
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Turkey
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</option>
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<option>
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United Arab Emi
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</option>
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<option>
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United Kingdom
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</option>
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<option>
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Uruguay
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</option>
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<option>
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Vatican City
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</option>
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<option>
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Venezuela
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</option>
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</select></td>
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</tr>
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<tr>
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<td>
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</td>
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</tr>
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<tr>
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<td><font size=
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"2">Day Phone</font></td>
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<td><input name="ShipTo.Phone" size="18" maxlength="18"
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value=""></td>
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</tr>
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<tr>
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<td><font size=
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"2">Night Phone</font></td>
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<td><input name="ShipTo.AltPhone" size="18" maxlength="18"
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value=""></td>
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</tr>
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<tr>
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<td><font size=
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"2">E-mail</font></td>
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<td><input name="ShipTo.Email" size="35" maxlength="55"
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value=""></td>
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</tr>
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</table>
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<p><font size="2">
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<font size="2">*
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(Please do not abbreviate city.)</font></font></p>
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<table width="440" cellpadding="4" cellspacing="0"
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border="0" bgcolor="#99ccff">
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<tr>
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<td><font
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size="3"><b>Billing Information</b></font></td>
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</tr>
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</table>
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<table border="0">
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<tr>
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<td><font size=
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"2">Address Line 1</font></td>
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<td><input name="BillTo.Street.Line1" size="29" maxlength="29"
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value=""></td>
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</tr>
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<tr>
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<td><font size=
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"2">Address Line 2</font></td>
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<td><input name="BillTo.Street.Line2" size="29" maxlength="29"
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value=""></td>
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</tr>
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<tr>
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<td><font size=
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"2">City, State</font></td>
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<td><input name="BillTo.City" size="24" maxlength="25"
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value="">, <input name="BillTo.State" size="3" maxlength=
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"20" value=""></td>
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</tr>
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<tr>
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<td><font size=
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"2">ZIP</font></td>
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<td><input name="BillTo.PostalCode" size="10" maxlength="10"
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value=""></td>
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</tr>
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<tr>
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<td><font size=
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"2">Country</font></td>
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<td><select name="BillTo.Country" size="4">
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<option selected>
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USA
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</option>
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<option>
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Argentina
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</option>
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<option>
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Australia
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</option>
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<option>
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Austria
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</option>
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<option>
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Belgium
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</option>
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<option>
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Bermuda
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</option>
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<option>
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Brazil
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</option>
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<option>
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Canada
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</option>
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<option>
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Cayman Islands
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</option>
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<option>
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Chile
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</option>
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<option>
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China
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</option>
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<option>
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Colombia
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</option>
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<option>
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Corsica
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</option>
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<option>
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Costa Rica
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</option>
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<option>
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Croatia
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</option>
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<option>
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Cyprus
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</option>
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<option>
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Czech Republic
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</option>
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<option>
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Denmark
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</option>
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<option>
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Ecuador
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</option>
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<option>
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Egypt
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</option>
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<option>
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Estonia
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</option>
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<option>
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Fiji
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</option>
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<option>
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Finland
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</option>
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<option>
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France
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</option>
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<option>
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French Polynesia
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</option>
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<option>
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Germany
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</option>
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<option>
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Greece
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</option>
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<option>
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Grenada
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</option>
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<option>
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Hong Kong
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</option>
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<option>
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Hungary
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</option>
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<option>
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Iceland
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</option>
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<option>
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India
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</option>
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<option>
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Indonesia
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</option>
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<option>
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Ireland
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</option>
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<option>
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Israel
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</option>
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<option>
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Italy
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</option>
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<option>
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Japan
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</option>
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<option>
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Kuwait
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</option>
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<option>
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Latvia
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</option>
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<option>
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Lithuania
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</option>
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<option>
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Luxembourg
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</option>
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<option>
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Malaysia
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</option>
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<option>
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Malta
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</option>
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<option>
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Martinique
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</option>
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<option>
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Mauritius
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</option>
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<option>
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Mexico
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</option>
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<option>
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Netherlands
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</option>
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<option>
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Nether Antil
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</option>
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<option>
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New Caledonia
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</option>
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<option>
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New Zealand
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</option>
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<option>
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Norway
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</option>
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<option>
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Panama
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</option>
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<option>
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Paraguay
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</option>
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<option>
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Peru
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</option>
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<option>
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Philippines
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</option>
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<option>
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Poland
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</option>
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<option>
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Portugal
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</option>
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<option>
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Qatar
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</option>
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<option>
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Russia
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</option>
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<option>
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Saudi Arabia
|
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</option>
|
|
|
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<option>
|
|
St Lucia
|
|
</option>
|
|
|
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<option>
|
|
Singapore
|
|
</option>
|
|
|
|
<option>
|
|
Slovakia
|
|
</option>
|
|
|
|
<option>
|
|
Slovenia
|
|
</option>
|
|
|
|
<option>
|
|
South Africa
|
|
</option>
|
|
|
|
<option>
|
|
South Korea
|
|
</option>
|
|
|
|
<option>
|
|
Spain
|
|
</option>
|
|
|
|
<option>
|
|
Sri Lanka
|
|
</option>
|
|
|
|
<option>
|
|
Sweden
|
|
</option>
|
|
|
|
<option>
|
|
Switzerland
|
|
</option>
|
|
|
|
<option>
|
|
Syria
|
|
</option>
|
|
|
|
<option>
|
|
Taiwan
|
|
</option>
|
|
|
|
<option>
|
|
Thailand
|
|
</option>
|
|
|
|
<option>
|
|
Trinidad & Toba
|
|
</option>
|
|
|
|
<option>
|
|
Turkey
|
|
</option>
|
|
|
|
<option>
|
|
United Arab Emi
|
|
</option>
|
|
|
|
<option>
|
|
United Kingdom
|
|
</option>
|
|
|
|
<option>
|
|
Uruguay
|
|
</option>
|
|
|
|
<option>
|
|
Vatican City
|
|
</option>
|
|
|
|
<option>
|
|
Venezuela
|
|
</option>
|
|
|
|
<option>
|
|
Other
|
|
</option>
|
|
</select></td>
|
|
</tr>
|
|
</table>
|
|
|
|
<p><font size="2">
|
|
<font size="2">*
|
|
(Please do not abbreviate city.)</font></font></p>
|
|
|
|
<p><font size="2">
|
|
<font size="2">
|
|
<input type="submit" value=" Create New Account ">
|
|
</font></font></p>
|
|
</form>
|
|
</td>
|
|
</tr>
|
|
|
|
</table>
|
|
</body>
|
|
</html>
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