Form Content:
<p><b>Address</b><br />
6825 West Sam Houston Pkwy. N,<br />
Houston, TX 77041<br />
<br />
<b>Mailing:</b><br />
PO Box 3826,<br />
Houston, TX 77253-3826<br />
<br />
<b>Phone:</b><br />
1.800.283.6266 or 713.466.1449<br />
<br />
<b>Fax:</b><br />
713.466.1703<br />
<br />
<b>Email:</b><br />
<a href="mailto:customerservice@EnconSafety.com">customerservice@EnconSafety.com</a></p>
<form
action="https://www.salesforce.com/servlet/servlet.WebToLead?encoding=UTF-8"
method="post"><input name="oid" value="00D400000009lll" type="hidden">
<input name="retURL" value="http://www.enconsafety.com" type="hidden">
<table style="text-align: left; width: 789px;" cellpadding="2"
cellspacing="2">
<tbody>
<tr>
<td style="width: 241px;"><label for="company">Company</label></td>
<td style="width: 528px;"><input id="company" maxlength="40"
name="company" size="20" type="text"></td>
</tr>
<tr>
<td style="width: 241px;"><label for="salutation">Salutation</label></td>
<td style="width: 528px;">
<select id="salutation" name="salutation">
<option value="">--None--</option>
<option value="Mr.">Mr.</option>
<option value="Ms.">Ms.</option>
<option value="Mrs.">Mrs.</option>
<option value="Dr.">Dr.</option>
<option value="Prof.">Prof.</option>
</select>
</td>
</tr>
<tr>
<td style="width: 241px;"><label for="first_name">First Name</label></td>
<td style="width: 528px;"><input id="first_name" maxlength="40"
name="first_name" size="20" type="text"></td>
</tr>
<tr>
<td style="width: 241px;"><label for="last_name">Last Name</label></td>
<td style="width: 528px;"><input id="last_name" maxlength="80"
name="last_name" size="20" type="text"></td>
</tr>
<tr>
<td style="width: 241px;"><label for="email">Email</label></td>
<td style="width: 528px;"><input id="email" maxlength="80"
name="email" size="20" type="text"></td>
</tr>
<tr>
<td style="width: 241px;"><label for="street">Address</label></td>
<td style="width: 528px;"><textarea name="street"></textarea></td>
</tr>
<tr>
<td style="width: 241px;"><label for="city">City</label></td>
<td style="width: 528px;"><input id="city" maxlength="40"
name="city" size="20" type="text"></td>
</tr>
<tr>
<td style="width: 241px;"><label for="state">State/Province</label></td>
<td style="width: 528px;"><input id="state" maxlength="20"
name="state" size="20" type="text"></td>
</tr>
<tr>
<td style="width: 241px;"><label for="phone">Phone</label></td>
<td style="width: 528px;"><input id="phone" maxlength="40"
name="phone" size="20" type="text"></td>
</tr>
<tr>
<td style="width: 241px;"><label for="mobile">Mobile</label></td>
<td style="width: 528px;"><input id="mobile" maxlength="40"
name="mobile" size="20" type="text"></td>
</tr>
<tr>
<td style="width: 241px;"><label for="lead_source">Where did
you first hear about us?</label></td>
<td style="width: 528px;">
<select id="lead_source" name="lead_source">
<option value="">--None--</option>
<option value="ISHN Magazine">ISHN
Magazine</option>
<option value="OHS Magazine">OHS
Magazine</option>
<option value="PTEN Magazine">PTEN
Magazine</option>
<option value="Customer Service">Customer
Service</option>
<option value="Trade Show">Trade
Show</option>
<option value="Encon Website">Encon
Website</option>
<option value="Other">Other</option>
<option value="EHS Magazine">EHS
Magazine</option>
</select>
</td>
</tr>
<tr>
<td style="width: 241px;"><label for="description">How can we
help you today?</label></td>
<td style="width: 528px;"><textarea name="description"></textarea></td>
</tr>
<tr>
<td style="width: 241px;"><input name="submit" type="submit" value="Submit"></td>
<td style="width: 528px;"></td>
</tr>
</tbody>
</table>
</form>
Address
6825 West Sam Houston Pkwy. N,
Houston, TX 77041
Mailing:
PO Box 3826,
Houston, TX 77253-3826
Phone:
1.800.283.6266 or 713.466.1449
Fax:
713.466.1703
Email:
customerservice@EnconSafety.com