Contact Us

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<form enctype="multipart/form-data" method="post" action="https://www.response-o-matic.com/mail.php" accept-charset="UTF-8">
	<div>
		<input type="hidden" name="acctid" id="acctid" value="xnvbukcmnz4myaa2" />
		<input type="hidden" name="formid" id="formid" value="1298012" />
		<input type="hidden" name="required_vars" id="required_vars" value="field-4e3c4cdb11ee2a9,name,email,field-75179845f9f1045" />
	</div>
	<table cellspacing="5" cellpadding="5" border="0">
		<tr>
			<td valign="top">
				<strong>Who would you like to reach? (Choose one)</strong>
			</td>
			<td valign="top">
				<select name="field-4e3c4cdb11ee2a9" id="field-4e3c4cdb11ee2a9">
					<option value="General Inquiry">General Inquiry</option>
					<option value="Machine Sales Information">Machine Sales Information</option>
				</select>
				
			</td>
		</tr>
		<tr>
			<td valign="top">
				<strong>Name (First, Last):</strong>
			</td>
			<td valign="top">
				<input type="text" name="name" id="name" size="40" value="" />
				
			</td>
		</tr>
		<tr>
			<td valign="top">
				<strong>Company or Organization</strong>
			</td>
			<td valign="top">
				<input type="text" name="field-14bcce9346ea999" id="field-14bcce9346ea999" size="40" value="" />
				
			</td>
		</tr>
		<tr>
			<td valign="top">
				<strong>Email Address:</strong>
			</td>
			<td valign="top">
				<input type="text" name="email" id="email" size="40" value="" />
				
			</td>
		</tr>
		<tr>
			<td valign="top">
				<strong>Type your inquiry below.</strong>
			</td>
			<td valign="top">
				<textarea name="field-75179845f9f1045" id="field-75179845f9f1045" rows="6" cols="40"></textarea>
				
			</td>
		</tr>
		<tr>
			<td colspan="2" align="center">
				<input type="submit" value=" Submit Form " />
			</td>
		</tr>
	</table>
</form>
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