<?xml version="1.0" encoding="UTF-8"?>

<form url="callback_request.php"
 window="_self"
 method="POST"
 fontname="MS Sans Serif"
 width="196"
 height="200"
 bkcolor="0xFFFFFF"
 transparent="f"
 fontcolor="0x000000"
 outlinecolor="0xFFFFFF"
 themecolor="0xC0C0C0"
 fontcolor2="#000000"
 bkcolor2="#FFFFFF"
 includeresults="false"
 emailuser="false"
 verifymessage="The e-mail address you entered does not match!"
 reqmessage="Please complete all fields"
 invalidemailmsg="does not appear to be a valid e-mail address. Would you like to change it?"
 transition="0"
 autoresponseincluderesults="f"
 autoresponseaddtotop="f"
 usephp="true"
disableclicktoactiveprompt="false"
 extensions="*.txt;*.gif;*.jpg;*.jpeg;*.zip;*.doc;*.png;*.pdf;*.rtf;*.html;*.docx;*.xslx"
>

<hidden
 name="thankyoupage"
 value="http://www.njcarroll.ie/requestprocessed.html"
></hidden>

<hidden
 name="subject"
 value="Callback request from NJ Carroll Website"
></hidden>

<image
 image="back.jpg"
 x="0"
 y="0"
 bk="true"
></image>

<textinput
 name="Name"
 x="7"
 y="23"
 w="184"
 h="22"
 initvalue=""
 maxchars="40"
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
 editable="true"
>
</textinput>

<textinput
 name="Email"
 x="8"
 y="73"
 w="184"
 h="22"
 initvalue=""
 maxchars="40"
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
 emailbox="true"
 editable="true"
  restrict="email"
>
</textinput>

<textinput
 name="Phone"
 x="7"
 y="123"
 w="184"
 h="22"
 initvalue=""
 maxchars="40"
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
 editable="true"
>
</textinput>

<submitbutton
 name="Submit Button"
 x="13"
 y="168"
 w="171"
 h="29"
 label="Request Callback"
 fontname="@Adobe Fan Heiti Std B"
 fontcolor="0x333333"
  fontsize="12"
></submitbutton>

<label
 name="My Text 1"
 x="7"
 y="3"
 w="39"
 h="16"
 text="Name"
  fontname="@Adobe Fan Heiti Std B"
  fontcolor="0x333333"
  fontsize="13"
></label>

<label
 name="My Text 2"
 x="8"
 y="53"
 w="36"
 h="16"
 text="Email"
  fontname="@Adobe Fan Heiti Std B"
  fontcolor="0x333333"
  fontsize="13"
></label>

<label
 name="My Text 3"
 x="6"
 y="104"
 w="43"
 h="16"
 text="Phone"
  fontname="@Adobe Fan Heiti Std B"
  fontcolor="0x333333"
  fontsize="13"
></label>

</form>