Page 1 of 1

php feedback form with html

Posted: Mon Nov 23, 2009 11:01 pm
by bakul_kaushik
hi everybody,
my feedback form is not working. mails are not received to the given address. i have used html and for server side i have used php. Please help!!

The code is for feedback.php :--
<?php


// ------------- CONFIGURABLE SECTION ------------------------

// $mailto - set to the email address you want the form
// sent to, eg
//$mailto = "youremailaddress@example.com" ;

$mailto = 'info@benaka.in,bakul@benaka.in' ;

// $subject - set to the Subject line of the email, eg
//$subject = "Feedback Form" ;

$subject = "Feedback" ;


$formurl = "http://www.benaka.in/Feedback.html" ;
$errorurl = "http://www.benaka.in/error.html" ;
$thankyouurl = "http://www.benaka.in/index.html" ;

$email_is_required = 1;
$name_is_required = 1;
$comments_is_required = 1;
$mobile_is_required = 0;
$hear_is_required=0;
$address_is_required = 0;
$uself = 1;
$use_envsender = 0;
$use_sendmailfrom = 1;
$use_webmaster_email_for_from = 0;
$use_utf8 = 1;
$my_recaptcha_private_key = '' ;

// -------------------- END OF CONFIGURABLE SECTION ---------------

$headersep = (!isset( $uself ) || ($uself == 0)) ? "\r\n" : "\n" ;
$content_type = (!isset( $use_utf8 ) || ($use_utf8 == 0)) ? 'Content-Type: text/plain; charset="iso-8859-1"' : 'Content-Type: text/plain; charset="utf-8"' ;
if (!isset( $use_envsender )) { $use_envsender = 0 ; }
if (isset( $use_sendmailfrom ) && $use_sendmailfrom) {
ini_set( 'sendmail_from', $mailto );
}
$envsender = "-f$mailto" ;
$fullname = (isset($_POST['fullname']))? $_POST['fullname'] : $_POST['name'] ;
$email = $_POST['email'] ;
$hear=$_POST['hear'];
$mobile = $_POST['mobile'];
$address = $_POST['address'];
$comments = $_POST['comments'] ;
$http_referrer = getenv( "HTTP_REFERER" );

if (!isset($_POST['email'])) {
header( "Location: $formurl" );
exit ;
}
if (($email_is_required && (empty($email) || !preg_match('/@/', $email))) || ($name_is_required && empty($fullname)) || ($comments_is_required && empty($comments))) {
header( "Location: $errorurl" );
exit ;
}
if ( preg_match( "/[\r\n]/", $fullname ) || preg_match( "/[\r\n]/", $email ) ) {
header( "Location: $errorurl" );
exit ;
}
if (strlen( $my_recaptcha_private_key )) {
require_once( 'recaptchalib.php' );
$resp = recaptcha_check_answer ( $my_recaptcha_private_key, $_SERVER['REMOTE_ADDR'], $_POST['recaptcha_challenge_field'], $_POST['recaptcha_response_field'] );
if (!$resp->is_valid) {
header( "Location: $errorurl" );
exit ;
}
}
if (empty($email)) {
$email = $mailto ;
}
$fromemail = (!isset( $use_webmaster_email_for_from ) || ($use_webmaster_email_for_from == 0)) ? $email : $mailto ;

if (function_exists( 'get_magic_quotes_gpc' ) && get_magic_quotes_gpc()) {
$comments = stripslashes( $comments );
}

$messageproper =
"This message was sent from:\n" .
"$http_referrer\n" .
"------------------------------------------------------------\n" .
"Name of sender: $fullname\n" .
"Email of sender: $email\n" .
"Contact no of sender : $mobile\n" .
"Address of sender : $address\n" .
"How did you hear about this website : $hear\n" .
"------------------------- Feedback -------------------------\n\n" .
$comments .
"\n\n------------------------------------------------------------\n" ;

$headers =
"From: \"$fullname\" <$fromemail>" . $headersep . "Reply-To: \"$fullname\" <$email>" . $headersep . "X-Mailer: chfeedback.php 2.15.0" .
$headersep . 'MIME-Version: 1.0' . $headersep . $content_type ;

if ($use_envsender) {
mail($mailto, $subject, $messageproper, $headers, $envsender );
}
else {
mail($mailto, $subject, $messageproper, $headers );
}
header( "Location: $thankyouurl" );
exit ;

?>










the html form is :---
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1" />
<title>B E N A K A Business Consultancy</title>
<link href="images/links.css" rel="stylesheet" type="text/css" />
<style type="text/css">
<!--
.style1 { color: #88B2E2;
font-weight: bold;
}
.style8 {
font-family: Verdana, Arial, Helvetica, sans-serif;
font-size: 9px;
}
.style11 {font-size: 12px}
.style14 {font-family: Verdana, Arial, Helvetica, sans-serif}
.style19 {font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 12px; font-weight: bold; }
.style21 {color: #B93131}
.style23 {color: #B93131; font-weight: bold; }
.style25 {color: #646464; font-size: 10px;}
-->
</style>
<script language="JavaScript">
<!--
function mmLoadMenus() {
if (window.mm_menu_0101000743_0) return;
window.mm_menu_0101000743_0 = new Menu("root",131,17,"Arial, Helvetica, sans-serif",11,"#FFFFFF","#FFFFFF","#6591DA","#1E1E2B","left","middle",3,0,1000,-5,7,true,true,true,0,true,true);
mm_menu_0101000743_0.addMenuItem("Our&nbsp;Vision","location='Our Vision.html'");
mm_menu_0101000743_0.addMenuItem("Our&nbsp;Mission","location='Our Mission.html'");
mm_menu_0101000743_0.addMenuItem("Our&nbsp;Values","location='Our Values.html'");
mm_menu_0101000743_0.addMenuItem("Our&nbsp;Methodology","location='Our Methodology.html'");
mm_menu_0101000743_0.addMenuItem("Our&nbsp;Approach","location='Our Approach.html'");
mm_menu_0101000743_0.addMenuItem("Our&nbsp;Management","location='Our Management.html'");
mm_menu_0101000743_0.fontWeight="bold";
mm_menu_0101000743_0.hideOnMouseOut=true;
mm_menu_0101000743_0.bgColor='#FFFFFF';
mm_menu_0101000743_0.menuBorder=0;
mm_menu_0101000743_0.menuLiteBgColor='#FFFFFF';
mm_menu_0101000743_0.menuBorderBgColor='#FFFFFF';

window.mm_menu_0101001508_0_1 = new Menu("Business&nbsp;Consultancy",145,17,"Arial, Helvetica, sans-serif",11,"#FFFFFF","#FFFFFF","#6591DA","#1E1E2B","left","middle",3,0,1000,-5,7,true,true,true,0,true,true);
mm_menu_0101001508_0_1.addMenuItem("Business&nbsp;Incubation&nbsp;","location='Business Incubation.html '");
mm_menu_0101001508_0_1.addMenuItem("Mentorship","location='Mentorship.html '");
mm_menu_0101001508_0_1.fontWeight="bold";
mm_menu_0101001508_0_1.hideOnMouseOut=true;
mm_menu_0101001508_0_1.bgColor='#FFFFFF';
mm_menu_0101001508_0_1.menuBorder=0;
mm_menu_0101001508_0_1.menuLiteBgColor='#FFFFFF';
mm_menu_0101001508_0_1.menuBorderBgColor='#FFFFFF';
window.mm_menu_0101001508_0_2 = new Menu("Marketing&nbsp;Consultancy",137,17,"Arial, Helvetica, sans-serif",11,"#FFFFFF","#FFFFFF","#6591DA","#1E1E2B","left","middle",3,0,1000,-5,7,true,true,true,0,true,true);
mm_menu_0101001508_0_2.addMenuItem("Brand&nbsp;Consultancy","location='Brand Consultancy.html'");
mm_menu_0101001508_0_2.addMenuItem("Corporate&nbsp;Identity","location='Corporate Identity.html'");
mm_menu_0101001508_0_2.fontWeight="bold";
mm_menu_0101001508_0_2.hideOnMouseOut=true;
mm_menu_0101001508_0_2.bgColor='#FFFFFF';
mm_menu_0101001508_0_2.menuBorder=0;
mm_menu_0101001508_0_2.menuLiteBgColor='#FFFFFF';
mm_menu_0101001508_0_2.menuBorderBgColor='#FFFFFF';
window.mm_menu_0101001508_0_3 = new Menu("Website&nbsp;Consultancy",156,17,"Arial, Helvetica, sans-serif",11,"#FFFFFF","#FFFFFF","#6591DA","#1E1E2B","left","middle",3,0,1000,-5,7,true,true,true,0,true,true);
mm_menu_0101001508_0_3.addMenuItem("Website&nbsp;Development","location='Website Development.html'");
mm_menu_0101001508_0_3.addMenuItem("Website&nbsp;redesign","location='Website redesign.html'");
mm_menu_0101001508_0_3.addMenuItem("Flash&nbsp;Development","location='Flash Development.html'");
mm_menu_0101001508_0_3.addMenuItem("SEO&nbsp;Services","location='SEO Services.html'");
mm_menu_0101001508_0_3.fontWeight="bold";
mm_menu_0101001508_0_3.hideOnMouseOut=true;
mm_menu_0101001508_0_3.bgColor='#FFFFFF';
mm_menu_0101001508_0_3.menuBorder=0;
mm_menu_0101001508_0_3.menuLiteBgColor='#FFFFFF';
mm_menu_0101001508_0_3.menuBorderBgColor='#FFFFFF';
window.mm_menu_0101001508_0_4 = new Menu("E&nbsp;commerce&nbsp;Cunsultancy",163,17,"Arial, Helvetica, sans-serif",11,"#FFFFFF","#FFFFFF","#6591DA","#1E1E2B","left","middle",3,0,1000,-5,7,true,true,true,0,true,true);
mm_menu_0101001508_0_4.addMenuItem("&nbsp;E&nbsp;commerce&nbsp;solutions","location=' E commerce solutions.html'");
mm_menu_0101001508_0_4.addMenuItem("Shopping&nbsp;Cart&nbsp;Solution","location='Shopping Cart Solution.html'");
mm_menu_0101001508_0_4.addMenuItem("Payment&nbsp;Gateways","location='Payment Gateways.html'");
mm_menu_0101001508_0_4.fontWeight="bold";
mm_menu_0101001508_0_4.hideOnMouseOut=true;
mm_menu_0101001508_0_4.bgColor='#FFFFFF';
mm_menu_0101001508_0_4.menuBorder=0;
mm_menu_0101001508_0_4.menuLiteBgColor='#FFFFFF';
mm_menu_0101001508_0_4.menuBorderBgColor='#FFFFFF';
window.mm_menu_0101001508_0 = new Menu("root",186,17,"Arial, Helvetica, sans-serif",11,"#FFFFFF","#FFFFFF","#6591DA","#1E1E2B","left","middle",3,0,1000,-5,7,true,true,true,0,true,true);
mm_menu_0101001508_0.addMenuItem(mm_menu_0101001508_0_1,"location='Business Consultancy.html'");
mm_menu_0101001508_0.addMenuItem("Technology&nbsp;Consultancy","location='Technology Consultancy.html'");
mm_menu_0101001508_0.addMenuItem("Finance&nbsp;Consultancy","location=' Finance Consultancy.html'");
mm_menu_0101001508_0.addMenuItem(mm_menu_0101001508_0_2,"location='Marketing Consultancy.html'");
mm_menu_0101001508_0.addMenuItem("Organizational&nbsp;Consultancy","location='Organizational Consultancy.html'");
mm_menu_0101001508_0.addMenuItem(mm_menu_0101001508_0_3,"location='Website Consultancy.html'");
mm_menu_0101001508_0.addMenuItem(mm_menu_0101001508_0_4,"location='E commerce Consultancy.html'");
mm_menu_0101001508_0.addMenuItem("Maintenance&nbsp;and&nbsp;Support","location='Maintenance and Support.html'");
mm_menu_0101001508_0.fontWeight="bold";
mm_menu_0101001508_0.hideOnMouseOut=true;
mm_menu_0101001508_0.childMenuIcon="arrows.gif";
mm_menu_0101001508_0.bgColor='#FFFFFF';
mm_menu_0101001508_0.menuBorder=0;
mm_menu_0101001508_0.menuLiteBgColor='#FFFFFF';
mm_menu_0101001508_0.menuBorderBgColor='#FFFFFF';
window.mm_menu_0101002612_0 = new Menu("root",136,17,"Arial, Helvetica, sans-serif",11,"#FFFFFF","#FFFFFF","#6591DA","#1E1E2B","left","middle",3,0,1000,-5,7,true,true,true,0,true,true);
mm_menu_0101002612_0.addMenuItem("Why&nbsp;Join&nbsp;Benaka?","location='whybenaka.html'");
mm_menu_0101002612_0.addMenuItem("Work&nbsp;Culture","location='Work Culture.html'");
mm_menu_0101002612_0.addMenuItem("Opportunities","location='Opportunities.html'");
mm_menu_0101002612_0.addMenuItem("Skill&nbsp;sets","location=' Skill sets.html'");
mm_menu_0101002612_0.fontWeight="bold";
mm_menu_0101002612_0.hideOnMouseOut=true;
mm_menu_0101002612_0.bgColor='#FFFFFF';
mm_menu_0101002612_0.menuBorder=0;
mm_menu_0101002612_0.menuLiteBgColor='#FFFFFF';
mm_menu_0101002612_0.menuBorderBgColor='#FFFFFF';
window.mm_menu_0101002726_0 = new Menu("root",104,17,"Arial, Helvetica, sans-serif",11,"#FFFFFF","#FFFFFF","#6591DA","#1E1E2B","left","middle",3,0,1000,-5,7,true,true,true,0,true,true);
mm_menu_0101002726_0.addMenuItem("Liability","location='Liability.html'");
mm_menu_0101002726_0.addMenuItem("Disclaimer","location='Disclaimer.html'");
mm_menu_0101002726_0.addMenuItem("Data&nbsp;Security","location='Data Security.html'");
mm_menu_0101002726_0.fontWeight="bold";
mm_menu_0101002726_0.hideOnMouseOut=true;
mm_menu_0101002726_0.bgColor='#FFFFFF';
mm_menu_0101002726_0.menuBorder=0;
mm_menu_0101002726_0.menuLiteBgColor='#FFFFFF';
mm_menu_0101002726_0.menuBorderBgColor='#FFFFFF';

window.mm_menu_0101003658_0 = new Menu("root",83,17,"Arial, Helvetica, sans-serif",11,"#FFFFFF","#FFFFFF","#6591DA","#1E1E2B","left","middle",3,0,1000,-5,7,true,true,true,0,true,true);
mm_menu_0101003658_0.addMenuItem("Feedback","location='feedback.html'");
mm_menu_0101003658_0.fontWeight="bold";
mm_menu_0101003658_0.hideOnMouseOut=true;
mm_menu_0101003658_0.bgColor='#FFFFFF';
mm_menu_0101003658_0.menuBorder=0;
mm_menu_0101003658_0.menuLiteBgColor='#FFFFFF';
mm_menu_0101003658_0.menuBorderBgColor='#FFFFFF';

mm_menu_0101003658_0.writeMenus();
} // mmLoadMenus()
//-->
</script>
<script language="JavaScript" src="mm_menu.js"></script>
</head>

<body>
<script language="JavaScript1.2">mmLoadMenus();</script>
<table width="100%" height="632" border="0" cellpadding="0" cellspacing="0">
<tr>
<td width="33%" rowspan="2" valign="top"><img src="images/logo.jpg" width="330" height="58" /></td>
<td width="67%" height="30"><div align="right"><span class="style14"><span class="link"><a href="index.html" class="b">Home</a>&nbsp;</span><span class="b">&nbsp;<img src="../html_pject/images/dot_bar.jpg" width="1" height="12" />&nbsp;&nbsp;<a href="sitemap.html" class="b">Sitemap</a> &nbsp;<img src="../html_pject/images/dot_bar.jpg" width="1" height="12" />&nbsp;&nbsp;<a href="Opportunities.html" class="b">Careers</a> &nbsp;<img src="../html_pject/images/dot_bar.jpg" width="1" height="12" />&nbsp;&nbsp;&nbsp;<a href="Contact Us.html" class="b">Contact us</a></span></span></div></td>
</tr>
<tr>
<td height="19">&nbsp;</td>
</tr>
<tr>
<td height="84" colspan="2"><object classid="clsid:D27CDB6E-AE6D-11cf-96B8-444553540000" codebase="http://download.macromedia.com/pub/shoc ... n=7,0,19,0" width="990" height="155">
<param name="movie" value="images/index.swf" />
<param name="quality" value="high" />
<embed src="images/index.swf" quality="high" pluginspage="http://www.macromedia.com/go/getflashplayer" type="application/x-shockwave-flash" width="990" height="155"></embed>
</object></td>
</tr>
<tr>
<td height="21" colspan="2" bgcolor="#3D70BC"><span class="link">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span><span class="link">&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<img src="images/arrow.png" width="6" height="5" />&nbsp;&nbsp;<a href="About us.html" name="link2" class="link" id="link1" onmouseover="MM_showMenu(window.mm_menu_0101000743_0,0,15,null,'link2')" onmouseout="MM_startTimeout();">About us</a>&nbsp;</span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<span class="link"><img src="images/arrow.png" width="6" height="5" /></span>&nbsp;<span class="link"><a href="Our Services.html" name="link7" class="link" id="link3" onmouseover="MM_showMenu(window.mm_menu_0101001508_0,0,15,null,'link7')" onmouseout="MM_startTimeout();">Our Services</a></span>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<span class="link"><img src="images/arrow.png" width="6" height="5" /></span>&nbsp;&nbsp;<span class="link"><a href="Our people.html" name="link8" class="link" id="link5" onmouseover="MM_showMenu(window.mm_menu_0101002612_0,0,15,null,'link8')" onmouseout="MM_startTimeout();">Our People</a></span><a href="Our people.html"></a>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<span class="link"><img src="images/arrow.png" width="6" height="5" /></span>&nbsp;&nbsp;<span class="link"><a href="contact us.html" name="link9" class="link" id="link6" onmouseover="MM_showMenu(window.mm_menu_0101003658_0,0,15,null,'link9')" onmouseout="MM_startTimeout();">Contact Us</a></span> </td>
</tr>
<tr>
<td height="356" colspan="2"><table width="100%" height="318" border="0" cellpadding="3" cellspacing="4">
<tr>
<td width="22%" height="318" align="left" valign="top">
<table width="98%" height="254" border="0" cellpadding="2" cellspacing="1" bgcolor="#C1D3FB">
<tr>
<td height="252" align="center" valign="top" bgcolor="#FFFFFF"><table width="100%" border="0" cellspacing="0" cellpadding="0">
<tr>
<td height="264" align="left" valign="top"><p class="style19">Privacy</p>
<p class="style8">Benaka respects your privacy and takes comprehensive measures to safeguard your personal and business information. We will not share your credentials and business data with any &nbsp;&nbsp;&nbsp;&nbsp;third parties without your permission.<br />
<br />
Multi-levelcorporate security policiesand procedures ensure prevention from loss, misuse or unauthorized distribution of any business-sensitive information you share with us. </p></td>
</tr>
</table></td>
</tr>
</table>
<p class="style19">&nbsp;</p>
<p class="style19">&nbsp;</p>
<span class="text"></span><br /></td><td width="54%" valign="top" class="content"><table width="100%" height="22" border="0" cellpadding="0" cellspacing="0" bgcolor="#EAEAEA">
<tr>
<td class="sitemap">&nbsp; &#8212;><a href="Contact Us.html" class="sitemap">Contact Us</a>&nbsp; &#8212;><a href="Feedback.html" class="sitemap">Feedback</a></td>
</tr>
</table>
<div align="justify" class="text">
<table width="103%" height="24" border="0.5" cellpadding="0" cellspacing="0" bordercolor="#FFFFFF" bgcolor="#B9D8FD">
<tr>
<td width="1%" height="24" valign="top" bgcolor="#7D99DB"></td>
<td width="99%" valign="middle" bgcolor="#CDE8F8"><span class="style1">&nbsp;&nbsp;</span><strong class="style6">FEEDBACK</strong></td>
</tr>
</table><form action="feedback.php" method="post">
<table width="100%" border="0" cellspacing="0" cellpadding="4">
<tr>
<td width="4%" height="206" class="text"><p class="style8">&nbsp;</p>
</td>
<td width="96%" valign="top"><p>If you have a sound understanding in consultancy business, please feel free to give your valuable feedback or suggestion. This will help us to improve our quality of service and also understand our customers&rsquo; expectations in a better manner; finally you will get an attractive gift if you have given the best suggestion! Please visit all the web pages of <a href="http://www.benaka.in">www.benaka.in</a> and communicate us by phone or e-mail <a href="mailto:info@benaka.in">info@benaka.in</a> or write to us directly. </p>
<table width="99%" border="0" cellspacing="4" cellpadding="5">
<!--DWLayoutTable-->
<tr>
<td width="220"><span class="style11"><span class="style21">* </span>
<label for="tswname">Your Name :</label></span></td>
<td width="144"><input name="name" type="text" id="tswname" size="30" /></td>
</tr>
<tr>
<td width="220"><span class="style11"><span class="style21">* </span>
<label for="tswaddress">Contact Address : </label></span></td>
<td><input name="address" type="text" size="30" id="tswaddress" /></td>
</tr>
<tr>
<td width="220"><span class="style21">* </span>
<label for="tswmobile">Phone Number :</label></td>
<td><input name="mobile" type="text" size="30" id="tswmobile" /></td>
</tr>
<tr>
<td width="220"><span class="style21">* </span>
<label for="tswemail">Your current E-Mail Id :</label></td>
<td><input name="email" type="text" size="30" id="tswemail" /></td>
</tr>
<tr>
<td width="220" class="style11"><span class="style21">* </span>
<label for="tswhear">How did you hear about this website?:</label></td>
<td>
<input name="hear" type="text" size="30" id="tswehear" />
</td>
</tr>
<tr>
<td width="220" height="32" valign="top" class="style11"><span class="style21">* </span>
<label for="tswcomments">Feedback :</label></td>
<td height="32" valign="top" class="style11"><textarea name="comments" id="tswcomments" cols="23" rows="4"></textarea></td>
</tr>
<tr>
<td height="92" colspan="2" valign="top" class="style11"><br />
<br />
<label>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
<input name="submit" type="submit" value="Submit" />
&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </label>
<input name="reset" type="reset" value="Reset" />
<br />
<br />
<table width="100%" border="0" cellspacing="0" cellpadding="0">
<tr>
<td bgcolor="#EBF4FE"><span class="style23">* </span><span class="style25">Mandatory Fields </span></td>
</tr>
</table></td>
</tr>
</table></td>
</tr>
</table></form>
<p>&nbsp;</p>
</td>
<td width="24%" align="center" valign="top" class="content"><table width="217" height="136" border="0.5" cellpadding="2" cellspacing="1">
<tr>
<td width="211" height="134" valign="top" bgcolor="#FFFFFF"><img src="images/3_itm.jpg" width="209" height="130" border="0" usemap="#Map" />
<map name="Map" id="Map3">
<area shape="rect" coords="16,20,192,45" href="RFI.html" />
<area shape="rect" coords="15,54,192,83" href="CMB.html" />
<area shape="rect" coords="15,92,192,121" href="GFE.html" />
</map></td>
</tr>
</table>
<table width="209" height="136" border="0.5" cellpadding="2" cellspacing="1" bordercolor="#C8D8FB" bgcolor="#C6D6FD">
<tr>
<td width="203" height="134" valign="top" bgcolor="#FFFFFF"><div align="center"><img src="images/portfolio.jpg" width="206" height="128" border="0" usemap="#Map2" />
<map name="Map2" id="Map2">
<area shape="rect" coords="8,13,193,121" href="portfolio.html" />
</map>
</div></td>
</tr>
</table></td>
</tr>
</table>
<map name="Map" id="Map">
<area shape="rect" coords="16,20,192,45" href="RFI.html" />
<area shape="rect" coords="15,54,192,83" href="CMB.html" />
<area shape="rect" coords="15,92,192,121" href="GFE" />
</map></td>
</tr>
<tr>
<td height="19" colspan="2" bgcolor="#E1ECF4">&nbsp;</td>
</tr>
<tr>
<td height="19" colspan="2" bgcolor="#FFFFFF"><div align="left">
<table width="100%" border="0" cellspacing="0" cellpadding="0">
<tr>
<td width="25%"><span class="b"><a href="Privacy.html" class="b">Privacy policy</a> &nbsp;&nbsp;&nbsp;&nbsp;All Right Reserved 2009-2010.</span></td>
<td width="45%">&nbsp;</td>
<td width="30%"><div align="right"><span class="b"><a href="Liability.html" class="b">Liability</a> &nbsp;&nbsp;&nbsp;&nbsp;<a href="Disclaimer.html" class="b">Disclaimer</a> &nbsp;&nbsp;&nbsp;&nbsp;<a href="Data Security.html" class="b">Data Security</a> </span></div></td>
</tr>
</table>
</div></td>
</tr>
</table>
</body>
</html>