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<!--CONTENT START--> <span class="pagetitles"><b><br> ENQUIRY FORM</b></span><p></p> <p> <br> <form action="http://homepage.tinet.ie/cgi-bin/auto_mail.cgi" method="post"> <input type="HIDDEN" name="TO" value="enquiries@autogasnw.co.uk"> <input type="HIDDEN" name="SUBJECT" value="Website Enquiry"> <input type="HIDDEN" name="RETURN" value="http://www.autogasnw.co.uk/enquiry_text.html"> <table width="100%" border="0"> <tr> <td width="40%" class="heading">Vehicle Make:</td> <td width="7%" class="heading"> </td> <td width="53%" class="heading"> <input name="vehicle_make" type="text" id="vehicle_make"> </td> </tr> <tr> <td width="40%" class="heading">Model: </td> <td width="7%" class="heading"> </td> <td width="53%" class="heading"> <input type="text" name="model"> </td> </tr> <tr> <td width="40%" class="heading">Engine Size:</td> <td width="7%" class="heading"> </td> <td width="53%" class="heading"> <input name="engine_size" type="text" id="engine_size"> </td> </tr> <tr> <td width="40%" class="heading">Year of manufacture:</td> <td width="7%" class="heading"> </td> <td width="53%" class="heading"> <input name="year_manufactured" type="text" id="year_manufactured"> </td> </tr> <tr> <td width="40%" class="heading">Registration Letter:</td> <td width="7%" class="heading"> </td> <td width="53%" class="heading"> <input name="registration_letter" type="text" id="registration_letter"> </td> </tr> <tr> <td width="40%" class="heading">Engine Code:</td> <td width="7%" class="heading"> </td> <td width="53%" class="heading"> <input name="engine_code" type="text" id="engine_code"> </td> </tr> <tr> <td colspan="3" class="heading">(found in manufacturers handbook) </td> </tr> <tr> <td width="40%" class="heading">Engine Type:</td> <td width="7%" class="heading"> </td> <td width="53%" class="heading"> <input type="checkbox" name="automatic" value="checkbox"> automatic </td> </tr> <tr> <td width="40%" class="heading"> </td> <td width="7%" class="heading"> </td> <td width="53%" class="heading"> <input type="checkbox" name="manual" value="checkbox"> manual </td> </tr> <tr> <td width="40%" class="heading"> </td> <td width="7%" class="heading"> </td> <td width="53%" class="heading"> <input name="injection" type="checkbox" id="injection" value="checkbox"> Injection </td> </tr> <tr> <td width="40%" class="heading"> </td> <td width="7%" class="heading"> </td> <td width="53%" class="heading"> <input name="carburettor" type="checkbox" id="carburettor" value="checkbox"> Carburettor </td> </tr> <tr> <td width="40%" class="heading"> </td> <td width="7%" class="heading"> </td> <td width="53%" class="heading"> </td> </tr> <tr> <td width="40%" class="heading">Type of Tank Preferred:</td> <td width="7%" class="heading"> </td> <td width="53%" class="heading"> <input name="do_nut" type="checkbox" id="do_nut" value="checkbox"> Do-nut </td> </tr> <tr> <td width="40%" class="heading"> </td> <td width="7%" class="heading"> </td> <td width="53%" class="heading"> <input name="cylinder" type="checkbox" id="cylinder" value="checkbox"> Cylinder </td> </tr> <tr> <td width="40%" class="heading"> </td> <td width="7%" class="heading"> </td> <td width="53%" class="heading"> </td> </tr> <tr> <td width="40%" valign="top" class="heading">Comments:</td> <td width="7%" class="heading"> </td> <td width="53%" class="heading"> <textarea name="comments" cols="30"></textarea> </td> </tr> <tr> <td width="40%" class="heading"> </td> <td width="7%" class="heading"> </td> <td width="53%" class="heading"> </td> </tr> <tr> <td width="40%" class="heading">Name:</td> <td width="7%" class="heading"> </td> <td width="53%" class="heading"> <input type="text" name="name" size="40"> </td> </tr> <tr> <td width="40%" valign="top" class="heading">Address:</td> <td width="7%" class="heading"> </td> <td width="53%" class="heading"> <textarea name="address" cols="30" rows="6"></textarea> </td> </tr> <tr> <td width="40%" class="heading"> </td> <td width="7%" class="heading"> </td> <td width="53%" class="heading"> </td> </tr> <tr> <td width="40%" class="heading">e-mail address:</td> <td width="7%" class="heading"> </td> <td width="53%" class="heading"> <input type="text" name="email" size="40"> </td> </tr> <tr> <td width="40%" class="heading"> </td> <td width="7%" class="heading"> </td> <td width="53%" class="heading"> </td> </tr> <tr> <td width="40%" class="heading">Telephone:</td> <td width="7%" class="heading"> </td> <td width="53%" class="heading"> <input type="text" name="telephone"> </td> </tr> <tr> <td width="40%" class="heading">Mobile:</td> <td width="7%" class="heading"> </td> <td width="53%" class="heading"> <input type="text" name="mobile"> </td> </tr> <tr> <td width="40%"> </td> <td width="7%"> </td> <td width="53%"> </td> </tr> <tr> <td width="40%"><div align="right"> <label> <input name="Reset" type="reset" id="Reset" value="Reset Form"> </label> </div></td> <td width="7%"> </td> <td width="53%" class="pagelinks"><label> <input type="submit" name="Submit" value="Submit"> </label></td> </tr> </table> </FORM> <p><br> </p><!--CONTENT END-->
