<form action="cdonts/contact3.asp" method="post" name="mailform" onSubmit="MM_validateForm('name','','R','email','','RisEmail');return document.MM_returnValue">
<table width="100%" border="0" bordercolor="#CCCCCC">
<tr>
<td width="25%" class="titleonwhite">Contact Details</td>
<td>Your Unique Enquiry Ref is 84489</td>
<td>
<input name="enqid" type="hidden" id="enqid" value="Response.Write strTemp"></td>
<td> </td>
</tr>
<tr bordercolor="#CCCCCC" class="textonwhite">
<td width="25%" bgcolor="#CCCCCC">Contact Name</td>
<td bgcolor="#CCCCCC"><input name="name" type="text" class="required" id="name">
*</td>
<td bgcolor="#CCCCCC">Company Name</td>
<td bgcolor="#CCCCCC"><input name="company" type="text" id="company" value=""></td>
</tr>
<tr bordercolor="#CCCCCC" class="textonwhite">
<td bgcolor="#CCCCCC">Email Address</td>
<td bgcolor="#CCCCCC"><input name="email" type="text" class="required" id="email">
*</td>
<td bgcolor="#CCCCCC">Telephone Number</td>
<td bgcolor="#CCCCCC"><input name="telephone no" type="text" id="telephone no"></td>
</tr>
<tr bordercolor="#CCCCCC" class="textonwhite">
<td bgcolor="#CCCCCC">Postcode/Zip</td>
<td bgcolor="#CCCCCC"><input name="postcode" type="text" id="postcode" value=""></td>
<td bgcolor="#CCCCCC">Address</td>
<td bgcolor="#CCCCCC"><textarea name="address" id="address"></textarea></td>
</tr>
<tr bgcolor="#CCCCCC" class="textonwhite">
<td>Additional Information</td>
<td><textarea name="information" id="information"></textarea></td>
<td colspan="2" valign="top" bordercolor="#CCCCCC" bgcolor="#FFFFFF"><p>If
you are interested in specific products or services then please
indicate which on the form below before submitting your details.
If you do not receive an enquiry reciept confirmation, please
email <a href="mailto:jwatson@delkor.co.uk">John Watson</a> or
call<br>
<strong>+44(0) 1761-417079</strong>.<br>
<br>
* indicates required field.</p>
<p align="right">
<input name="Submit" type="submit" onClick="MM_validateForm('name','','R','email','','RisEmail');return document.MM_returnValue" value="Submit Form">
<input type="reset" name="Submit2" value="Clear Form">
</p></td>
</tr>
</table>
<table width="100%" border="0">
<tr>
<td valign="top"><table width="100%" border="0">
<tr>
<td width="95%" class="titleonwhite">Products
<input name="hiddenField" type="hidden" value="Products/Services Selected..."></td>
<td width="5%"> </td>
</tr>
<tr bgcolor="#CCCCCC">
<td width="95%" valign="top" class="textonwhite">Bond Filters</td>
<td width="5%"><input type="checkbox" name="Products" value="Bond Filters"></td>
</tr>
<tr bgcolor="#CCCCCC">
<td width="95%" valign="top" class="textonwhite">Filter Presses</td>
<td width="5%"><input type="checkbox" name="Products" value="Filter Presses"></td>
</tr>
<tr bgcolor="#CCCCCC">
<td width="95%" valign="top" class="textonwhite">Hi-Rate & Conventional Thickeners</td>
<td width="5%"><input type="checkbox" name="Products" value="Hi-Rate & Conventional Thickeners"></td>
</tr>
<tr bgcolor="#CCCCCC">
<td width="95%" valign="top" class="textonwhite">Spiral Separators</td>
<td width="5%"><input type="checkbox" name="Products" value="Spiral Separators"></td>
</tr>
<tr bgcolor="#CCCCCC">
<td width="95%" valign="top" class="textonwhite">Tipping Pan Filters</td>
<td width="5%"><input type="checkbox" name="Products" value="Tipping Pan Filters"></td>
</tr>
<tr bgcolor="#CCCCCC">
<td width="95%" valign="top" class="textonwhite">Horizontal Belt Filters</td>
<td width="5%"><input type="checkbox" name="Products" value="Horizontal Belt Filters"></td>
</tr>
<tr bgcolor="#CCCCCC">
<td width="95%" valign="top" class="textonwhite">Ultra Hi-Rate & Paste Thickeners</td>
<td width="5%"><input type="checkbox" name="Products" value="Ultra Hi-Rate & Paste Thickeners"></td>
</tr>
<tr bgcolor="#CCCCCC">
<td width="95%" valign="top" class="textonwhite">Linear Screens</td>
<td width="5%"><input type="checkbox" name="Products" value="Linear Screens"></td>
</tr>
<tr bgcolor="#CCCCCC">
<td width="95%" valign="top" class="textonwhite">Fournier Rotary Presses</td>
<td width="5%"><input type="checkbox" name="Products" value="Fournier Rotary Presses"></td>
</tr>
<tr bgcolor="#CCCCCC">
<td width="95%" valign="top" class="textonwhite">Mixers & Agitators</td>
<td width="5%"><input type="checkbox" name="Products" value="Mixers & Agitators"></td>
</tr>
<tr bgcolor="#CCCCCC">
<td width="95%" valign="top" class="textonwhite">Pump Cells</td>
<td width="5%"><input type="checkbox" name="Products" value="Pump Cells"></td>
</tr>
<tr bgcolor="#CCCCCC">
<td width="95%" valign="top" class="textonwhite">Electrowinning Cells</td>
<td width="5%"><input type="checkbox" name="Products" value="Electrowinning Cells"></td>
</tr>
<tr bgcolor="#CCCCCC">
<td width="95%" valign="top" class="textonwhite">Carbon Kilns</td>
<td width="5%"><input type="checkbox" name="Products" value="Carbon Kilns"></td>
</tr>
<tr bgcolor="#CCCCCC">
<td width="95%" valign="top" class="textonwhite">Vortex Ring Mixers</td>
<td width="5%"><input type="checkbox" name="Products" value="Vortex Ring Mixers"></td>
</tr>
<tr bgcolor="#CCCCCC">
<td width="95%" valign="top" class="textonwhite">Flotation Cells</td>
<td width="5%"><input type="checkbox" name="Products" value="Flotation Cells"></td>
</tr>
</table></td>
<td valign="top"><table width="100%" border="0">
<tr>
<td width="95%" class="titleonwhite">Industry Areas</td>
<td width="5%"> </td>
</tr>
<tr bgcolor="#CCCCCC">
<td width="95%" valign="top" class="textonwhite">Phosphoric Acid</td>
<td width="5%">
<input type="checkbox" name="industry" value="Phosphoric Acid"></td>
</tr>
<tr bgcolor="#CCCCCC">
<td width="95%" valign="top" class="textonwhite">Mining/Mineral Processing</td>
<td width="5%">
<input type="checkbox" name="industry" value="Mining/Mineral Processing"></td>
</tr>
<tr bgcolor="#CCCCCC">
<td width="95%" valign="top" class="textonwhite">Metallurgical Processing</td>
<td width="5%">
<input type="checkbox" name="industry" value="Metallurgical Processing"></td>
</tr>
<tr bgcolor="#CCCCCC">
<td width="95%" valign="top" class="textonwhite">Power Industry Applications</td>
<td width="5%">
<input type="checkbox" name="industry" value="Power Industry Applications"></td>
</tr>
<tr bgcolor="#CCCCCC">
<td width="95%" valign="top" class="textonwhite">Bulk Chemical Processing</td>
<td width="5%">
<input type="checkbox" name="industry" value="Bulk Chemical Processing"></td>
</tr>
<tr bgcolor="#CCCCCC">
<td width="95%" valign="top" class="textonwhite">Fine Chemical Processing</td>
<td width="5%">
<input type="checkbox" name="industry" value="Fine Chemical Processing"></td>
</tr>
<tr bgcolor="#CCCCCC">
<td width="95%" valign="top" class="textonwhite">Pharmaceutical Processes</td>
<td width="5%">
<input type="checkbox" name="industry" value="Pharmaceutical Processes"></td>
</tr>
<tr bgcolor="#CCCCCC">
<td width="95%" valign="top" class="textonwhite">Automotive Plant</td>
<td width="5%">
<input type="checkbox" name="industry" value="Automotive Plant"></td>
</tr>
<tr bgcolor="#CCCCCC">
<td width="95%" valign="top" class="textonwhite">Water & Waste Water Treatment</td>
<td width="5%">
<input type="checkbox" name="industry" value="Water & Waste Water Treatment"></td>
</tr>
</table></td>
<td valign="top"><table width="100%" border="0">
<tr>
<td width="95%" class="titleonwhite">Services</td>
<td width="5%"> </td>
</tr>
<tr bgcolor="#CCCCCC">
<td width="95%" valign="top" class="textonwhite">Process Consulting</td>
<td width="5%">
<input type="checkbox" name="Processes" value="Process Consulting"></td>
</tr>
<tr bgcolor="#CCCCCC">
<td width="95%" valign="top" class="textonwhite">Service & Maintenance</td>
<td width="5%">
<input type="checkbox" name="Processes" value="Service & Maintenance"></td>
</tr>
<tr bgcolor="#CCCCCC">
<td width="95%" valign="top" class="textonwhite">Commissioning & De-bottlenecking</td>
<td width="5%">
<input type="checkbox" name="Processes" value="Commissioning & De-bottlenecking"></td>
</tr>
</table></td>
</tr>
</table>
</form>