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<meta name="GENERATOR" content="Microsoft FrontPage 3.0">
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<title>Secure Order Form</title>
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<table border="0" cellpadding="0" cellspacing="0">
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    <td width="125"><font color="#FF0000"><big>Aawsom<br>
    Technologies</big></font></td>
    <td width="5"></td>
    <td><h1><font color="#FF0000">Secure Order Form</font></h1>
    </td>
  </tr>
  <tr>
    <td width="125"></td>
    <td width="5" bgcolor="#FFFFFF"></td>
    <td bgcolor="#FFFFFF" align="left"><font face="Arial"><table border="5">
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        <td>
<!-- Start Insert Here -->
<form action="https://Secure2.Aawsom.net/forms/FormProcessor.asp" method="POST" name="Comment_Form">
  <input type="hidden" name="MailTo" value="CustomerService@YourWebsite.com">
  <input type="hidden" name="MailFromDefault" value="NoEmail@YourWebsite.com">
  <input type="hidden" name="MailFromField" value="Email">
  <input type="hidden" name="MailSubject" value="Contact">
  <input type="hidden" name="MailRedirect" value="www.YourWebsite.com/thanks.htm">
<%'  <input type="hidden" name="MailRedirectSecure" value="Secure2.Aawsom.net/VirtualXXX/YourUsername/secure/thanks.htm">%>
  <input type="hidden" name="Time" value="<%=Now()%>">
  <input type="hidden" name="Browser" value="<%=Request.ServerVariables("HTTP_User_Agent")%>">
<!-- End Insert Here -->
		<hr width="60%" color="#FF0000">
          <p>Please provide the following ordering information:</p>
          <table>
            <tr>
              <td><strong>QTY</strong></td>
              <td><strong>DESCRIPTION</strong></td>
            </tr>
            <tr>
              <td><input TYPE="TEXT" NAME="Order_Qty0" SIZE="6" MAXLENGTH="6"></td>
              <td><input TYPE="TEXT" NAME="Order_Dsc0" SIZE="45"></td>
            </tr>
            <tr>
              <td><input TYPE="TEXT" NAME="Order_Qty1" SIZE="6" MAXLENGTH="6"></td>
              <td><input TYPE="TEXT" NAME="Order_Dsc1" SIZE="45"></td>
            </tr>
            <tr>
              <td><input TYPE="TEXT" NAME="Order_Qty2" SIZE="6" MAXLENGTH="6"></td>
              <td><input TYPE="TEXT" NAME="Order_Dsc2" SIZE="45"></td>
            </tr>
            <tr>
              <td><input TYPE="TEXT" NAME="Order_Qty3" SIZE="6" MAXLENGTH="6"></td>
              <td><input TYPE="TEXT" NAME="Order_Dsc3" SIZE="45"></td>
            </tr>
            <tr>
              <td><input TYPE="TEXT" NAME="Order_Qty4" SIZE="6" MAXLENGTH="6"></td>
              <td><input TYPE="TEXT" NAME="Order_Dsc4" SIZE="45"></td>
            </tr>
            <tr>
              <td><strong>BILLING</strong></td>
              <td></td>
            </tr>
            <tr>
              <td><em>Credit card</em></td>
              <td><select NAME="Card__Type" size="1">
                <option SELECTED>VISA </option>
                <option>MasterCard </option>
                <option>American Express </option>
                <option>Diner's Club </option>
                <option>Discover </option>
              </select> </td>
            </tr>
            <tr>
              <td ALIGN="right"><em>Cardholder name</em></td>
              <td><input TYPE="TEXT" NAME="Card_Name" SIZE="35"> </td>
            </tr>
            <tr>
              <td ALIGN="right"><em>Card number</em></td>
              <td><input TYPE="TEXT" NAME="Card_Nmbr" SIZE="35"> </td>
            </tr>
            <tr>
              <td ALIGN="right"><em>Expiration date</em></td>
              <td><input TYPE="TEXT" NAME="Card__Exp" SIZE="5" MAXLENGTH="5"> </td>
            </tr>
            <tr>
              <td><strong>SHIPPING</strong></td>
              <td></td>
            </tr>
            <tr>
              <td ALIGN="right"><em>Street address</em></td>
              <td><input TYPE="TEXT" NAME="Addrs_Str1" SIZE="35"> </td>
            </tr>
            <tr>
              <td ALIGN="right"><em>Address (cont.)</em></td>
              <td><input TYPE="TEXT" NAME="Addrs_Str2" SIZE="35"> </td>
            </tr>
            <tr>
              <td ALIGN="right"><em>City</em></td>
              <td><input TYPE="TEXT" NAME="Addrs_City" SIZE="35"> </td>
            </tr>
            <tr>
              <td ALIGN="right"><em>State/Province</em></td>
              <td><input TYPE="TEXT" NAME="Addrs_Stat" SIZE="35"> </td>
            </tr>
            <tr>
              <td ALIGN="right"><em>Zip/Postal code</em></td>
              <td><input TYPE="TEXT" NAME="Addrs__Zip" SIZE="12" MAXLENGTH="12"> </td>
            </tr>
            <tr>
              <td ALIGN="right"><em>Country</em></td>
              <td><input TYPE="TEXT" NAME="Addrs_Ctry" SIZE="25"> </td>
            </tr>
            <tr>
              <td ALIGN="right"><em>Email Address</em></td>
              <td><input TYPE="TEXT" NAME="Email" SIZE="25"> </td>
            </tr>
          </table>
          <div align="center"><center><p><input TYPE="submit" VALUE="Submit Form">&nbsp; </p>
          </center></div><hr width="60%" color="#FF0000">
          <div align="center"><center><p><font><small>Designed by: <a href="http://www.Aawsom.net/sitedesign">Aawsom Technologies</a></small></font><br>
          <font color="#000000" face="Arial" size="1">Revised: <!--webbot bot="Timestamp" S-Type="EDITED" S-Format="%m/%d/%y %I:%M %p" startspan -->09/10/98 01:52 PM<!--webbot bot="Timestamp" endspan i-checksum="29431" --></font></p>
          </center></div><div align="center"><center><p></font>&nbsp;</p>
          </center></div>
        </form>
        </td>
      </tr>
    </table>
    </td>
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</table>
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