Puppies.htm

<body> <p>This page uses frames, but your browser doesn't support them.</p> <FONT size=1 face="Verdana, Arial, Helvetica, sans-serif"><BR><form name="contactForm" method="post" action="http://www.mycontactform.com/sendform/sendform.php"><BR><input name="user" type="hidden" id="user" value="alycegilmore" /><input name="formid" type="hidden" id="formid" value="341505" /><input name="subject" type="hidden" id="subject" value="Questionaire" /><BR><table width="100%" style="border: 0px solid #000000; margin: 0; padding: 0; background-color: #FFFFFF;"><tr><td><BR><table width="100%" border="0" cellspacing="0" cellpadding="5"><BR><tr bgcolor="#EFEFEF"><td><font color="#000000" size="2" face="Arial"><b> E-mail Address:<font color="#FF0000"> *</font></b></font></td><td><input name="email" type="text" id="email" size="20" maxlength="100" /></td></tr><tr bgcolor="#FFFFFF"><td><font color="#000000" size="2" face="Arial"><b>Name</b></font></td><td><font color="#000000" size="2" face="Arial"><input name="q[1]" type="text" value="" size="20" maxlength="" /></font></td></tr><tr bgcolor="#EFEFEF"><td><font color="#000000" size="2" face="Arial"><b>City</b></font></td><td><font color="#000000" size="2" face="Arial"><input name="q[2]" type="text" value="" size="20" maxlength="" /></font></td></tr><tr bgcolor="#FFFFFF"><td><font color="#000000" size="2" face="Arial"><b>State</b></font></td><td><font color="#000000" size="2" face="Arial"><select name="q[3]" > <option value="Alabama">Alabama</option> <option value="Alaska">Alaska</option> <option value="Arizona">Arizona</option> <option value="Arkansas">Arkansas</option> <option value="California">California</option> <option value="Colorado">Colorado</option> <option value="Connecticut">Connecticut</option> <option value="Delaware">Delaware</option> <option value="Florida">Florida</option> <option value="Georgia">Georgia</option> <option value="Hawaii">Hawaii</option> <option value="Idaho">Idaho</option> <option value="Illinois">Illinois</option> <option value="Indiana">Indiana</option> <option value="Iowa">Iowa</option> <option value="Kansas">Kansas</option> <option value="Kentucky">Kentucky</option> <option value="Louisiana">Louisiana</option> <option value="Maine">Maine</option> <option value="Maryland">Maryland</option> <option value="Massachusetts">Massachusetts</option> <option value="Michigan">Michigan</option> <option value="Minnesota">Minnesota</option> <option value="Mississippi">Mississippi</option> <option value="Missouri">Missouri</option> <option value="Montana">Montana</option> <option value="Nebraska">Nebraska</option> <option value="Nevada">Nevada</option> <option value="New Hampshire">New Hampshire</option> <option value="New Jersey">New Jersey</option> <option value="New Mexico">New Mexico</option> <option value="New York">New York</option> <option value="North Carolina">North Carolina</option> <option value="North Dakota">North Dakota</option> <option value="Ohio">Ohio</option> <option value="Oklahoma">Oklahoma</option> <option value="Oregon">Oregon</option> <option value="Pennsylvania">Pennsylvania</option> <option value="Rhode Island">Rhode Island</option> <option value="South Carolina">South Carolina</option> <option value="South Dakota">South Dakota</option> <option value="Tennessee">Tennessee</option> <option value="Texas">Texas</option> <option value="Utah">Utah</option> <option value="Vermont">Vermont</option> <option value="Virginia">Virginia</option> <option value="Washington">Washington</option> <option value="Washington, DC">Washington, DC</option> <option value="West Virginia">West Virginia</option> <option value="Wisconsin">Wisconsin</option> <option value="Wyoming">Wyoming</option> <option value="">--Territories--</option> <option value="American Samoa">American Samoa</option> <option value="Federated States of Micronesia">Federated States of Micronesia</option> <option value="Guam">Guam</option> <option value="Midway Islands">Midway Islands</option> <option value="Puerto Rico">Puerto Rico</option> <option value="U.S. Virgin Islands">U.S. Virgin Islands</option> </select></font></td></tr><tr bgcolor="#EFEFEF"><td><font color="#000000" size="2" face="Arial"><b>Type of Dwelling<font color="#FF0000"> *</font></b></font></td><td><font color="#000000" size="2" face="Arial"><input name="q[4]" type="hidden" value="checkbox341505" /><input name="checkbox4[]" type="checkbox" value="House" />House<br /><input name="checkbox4[]" type="checkbox" value="Duplex" />Duplex<br /><input name="checkbox4[]" type="checkbox" value="Apartment" />Apartment<br /><input name="checkbox4[]" type="checkbox" value="Mobile Home" />Mobile Home</font></td></tr><tr bgcolor="#FFFFFF"><td><font color="#000000" size="2" face="Arial"><b>Do you rent or own your home?<font color="#FF0000"> *</font></b></font></td><td><font color="#000000" size="2" face="Arial"><input name="q[5]" type="hidden" value="checkbox341505" /><input name="checkbox5[]" type="checkbox" value="Own" />Own<br /><input name="checkbox5[]" type="checkbox" value="Rent" />Rent</font></td></tr><tr bgcolor="#EFEFEF"><td><font color="#000000" size="2" face="Arial"><b>Is your yard fully and securely fenced? Describe<font color="#FF0000"> *</font></b></font></td><td><font color="#000000" size="2" face="Arial"><textarea name="q[6]" cols="30" rows="3" ></textarea></font></td></tr><tr bgcolor="#FFFFFF"><td><font color="#000000" size="2" face="Arial"><b>What type of fencing is your yard composed of?<font color="#FF0000"> *</font></b></font></td><td><font color="#000000" size="2" face="Arial"><textarea name="q[7]" cols="30" rows="3" ></textarea></font></td></tr><tr bgcolor="#EFEFEF"><td><font color="#000000" size="2" face="Arial"><b>Where will the dog be kept? (Choose one)<font color="#FF0000"> *</font></b></font></td><td><font color="#000000" size="2" face="Arial"><input name="q[8]" type="hidden" value="checkbox341505" /><input name="checkbox8[]" type="checkbox" value="Mainly Indoors" />Mainly Indoors<br /><input name="checkbox8[]" type="checkbox" value="In at night and out during the day" />In at night and out during the day<br /><input name="checkbox8[]" type="checkbox" value="Outside all the time" />Outside all the time</font></td></tr><tr bgcolor="#FFFFFF"><td><font color="#000000" size="2" face="Arial"><b>What size is your lot?</b></font></td><td><font color="#000000" size="2" face="Arial"><input name="q[9]" type="hidden" value="checkbox341505" /><input name="checkbox9[]" type="checkbox" value="Small" />Small<br /><input name="checkbox9[]" type="checkbox" value="Medium" />Medium<br /><input name="checkbox9[]" type="checkbox" value="Large" />Large</font></td></tr><tr bgcolor="#EFEFEF"><td><font color="#000000" size="2" face="Arial"><b>Will the dog be tied up?<font color="#FF0000"> *</font></b></font></td><td><font color="#000000" size="2" face="Arial"><input name="q[10]" type="hidden" value="checkbox341505" /><input name="checkbox10[]" type="checkbox" value="Yes" />Yes<br /><input name="checkbox10[]" type="checkbox" value="No" />No</font></td></tr><tr bgcolor="#FFFFFF"><td><font color="#000000" size="2" face="Arial"><b>Where will the dog be kept when home alone?<font color="#FF0000"> *</font></b></font></td><td><font color="#000000" size="2" face="Arial"><textarea name="q[11]" cols="30" rows="3" ></textarea></font></td></tr><tr bgcolor="#EFEFEF"><td><font color="#000000" size="2" face="Arial"><b>How many hours of the day will the puppy be left alone?</b></font></td><td><font color="#000000" size="2" face="Arial"><textarea name="q[12]" cols="30" rows="3" ></textarea></font></td></tr><tr bgcolor="#FFFFFF"><td><font color="#000000" size="2" face="Arial"><b>Have you owned a beagle before? List all current pets.</b></font></td><td><font color="#000000" size="2" face="Arial"><textarea name="q[13]" cols="30" rows="3" ></textarea></font></td></tr><tr bgcolor="#EFEFEF"><td><font color="#000000" size="2" face="Arial"><b>Is any one in the family allergic to pets?</b></font></td><td><font color="#000000" size="2" face="Arial"><textarea name="q[14]" cols="30" rows="3" ></textarea></font></td></tr><tr bgcolor="#FFFFFF"><td><font color="#000000" size="2" face="Arial"><b>Do you have any children?<font color="#FF0000"> *</font></b></font></td><td><font color="#000000" size="2" face="Arial"><input name="q[15]" type="hidden" value="checkbox341505" /><input name="checkbox15[]" type="checkbox" value="Yes" />Yes<br /><input name="checkbox15[]" type="checkbox" value="No" />No</font></td></tr><tr bgcolor="#EFEFEF"><td><font color="#000000" size="2" face="Arial"><b>What are the childrens ages?<font color="#FF0000"> *</font></b></font></td><td><font color="#000000" size="2" face="Arial"><textarea name="q[16]" cols="30" rows="3" ></textarea></font></td></tr><tr bgcolor="#FFFFFF"><td><font color="#000000" size="2" face="Arial"><b>Why do you want this dog?</b></font></td><td><font color="#000000" size="2" face="Arial"><textarea name="q[17]" cols="30" rows="3" ></textarea></font></td></tr><tr bgcolor="#EFEFEF"><td><font color="#000000" size="2" face="Arial"><b>What is your planned method of exercise?</b></font></td><td><font color="#000000" size="2" face="Arial"><textarea name="q[18]" cols="30" rows="3" ></textarea></font></td></tr><tr bgcolor="#FFFFFF"><td><font color="#000000" size="2" face="Arial"><b>What sex and color do you prefer?</b></font></td><td><font color="#000000" size="2" face="Arial"><textarea name="q[19]" cols="30" rows="3" ></textarea></font></td></tr><tr bgcolor="#EFEFEF"><td><font color="#000000" size="2" face="Arial"><b>What type of temperament are you looking for?</b></font></td><td><font color="#000000" size="2" face="Arial"><textarea name="q[20]" cols="30" rows="3" ></textarea></font></td></tr><tr bgcolor="#FFFFFF"><td><font color="#000000" size="2" face="Arial"><b>Would you be willing to accept a home inspection by myself or a friend prior to approcal for a puppy purchase?<font color="#FF0000"> *</font></b></font></td><td><font color="#000000" size="2" face="Arial"><input name="q[21]" type="hidden" value="checkbox341505" /><input name="checkbox21[]" type="checkbox" value="Yes" />Yes<br /><input name="checkbox21[]" type="checkbox" value="No" />No</font></td></tr><tr bgcolor="#EFEFEF"><td><font color="#000000" size="2" face="Arial"><b>Any other information you wish to add to assist in matching you with a puppy?</b></font></td><td><font color="#000000" size="2" face="Arial"><textarea name="q[22]" cols="30" rows="3" ></textarea></font></td></tr><tr><td colspan="2"><hr size="1" /></td></tr><BR><tr><td colspan="2"><input name="submit" type="submit" value="Submit" /> </td></tr><BR><tr><td><font color="#FF0000" size="1" face="Verdana, Arial, Helvetica, sans-serif"><b>*</b></font> <font size="1" face="Verdana, Arial, Helvetica, sans-serif">Required</font></td><td align="right"><font size="1" face="Verdana, Arial, Helvetica, sans-serif"><a href="http://www.mycontactform.com"><strong>Easy Online Form Builder</strong></a></font></td></tr><BR></table></td></tr></table></form><BR></FONT> </body>