<NLFORM> <!DOCTYPE html> <html > <head> <title>Online Lead

<!DOCTYPE html>

<html >

<head>

<title>Online Lead Form</title>

href="//netdna.bootstrapcdn.com/bootstrap/3.0.3/css/bootstrap.min.css">

<style>

textarea {

display: block !important;

width: 100% !important;

height: auto !important;

padding: 6px 12px !important;

font-size: 14px !important;

line-height: 1.42857143 !important;

color: #555 !important;

background-color: #fff !important;

background-image: none !important;

border: 1px solid #ccc !important;

border-radius: 4px !important;

box-shadow: inset 0 1px 1px rgba(0,0,0,.075) !important;

}

</style>

<style>

img.bg-img {

min-height: 100%;

height: auto;

position: fixed;

top: 0;

right: 0;

z-index: 0;

}

legend {

margin-top: 15px;

}

input,

button,

select,

textarea {

font-family: inherit;

font-size: inherit;

line-height: inherit;

}

input,

select {

display: block;

width: 100% !important;

height: 34px !important;

padding: 6px 12px;

font-size: 14px !important;

line-height: 1.428571429;

color: #555555;

vertical-align: middle;

background-color: #ffffff;

background-image: none;

border: 1px solid #cccccc;

border-radius: 4px;

-webkit-box-shadow: inset 0 1px 1px rgba(0, 0, 0, 0.075);

box-shadow: inset 0 1px 1px rgba(0, 0, 0, 0.075);

-webkit-transition: border-color ease-in-out .15s, box-shadow ease-in-out .15s;

transition: border-color ease-in-out .15s, box-shadow ease-in-out .15s;

}

input:focus,

select:focus {

border-color: #66afe9;

outline: 0;

-webkit-box-shadow: inset 0 1px 1px rgba(0,0,0,.075), 0 0 8px rgba(102, 175, 233, 0.6);

box-shadow: inset 0 1px 1px rgba(0,0,0,.075), 0 0 8px rgba(102, 175, 233, 0.6);

}

input:-moz-placeholder {

color: #999999;

}

input::-moz-placeholder {

color: #999999;

opacity: 1;

}

input:-ms-input-placeholder {

color: #999999;

}

input::-webkit-input-placeholder {

color: #999999;

}

input[disabled],

input[readonly],

fieldset[disabled] input {

cursor: not-allowed;

background-color: #eeeeee;

}

textarea {

height: auto;

}

button,

input,

select,

textarea {

font-family: inherit;

font-size: 100%;

margin: 0;

}

button,

input {

line-height: normal;

}

button,

select {

text-transform: none;

}

button,

html input[type="button"],

input[type="reset"],

input[type="submit"] {

-webkit-appearance: button;

cursor: pointer;

}

.form-group {

margin-bottom: 15px;

}

.form-action {

margin-top: 20px;

}

</style>

</head>

<body>

<img class="bg-img"

src="https://system.na1.netsuite.com/core/media/media.nl?id=3949&c=TSTDRV1136823&h=

de69b8c35db302223596">

<BR>

<h1>Questions? Comments? Contact Us.<small>Powered by

NetSuite</small></h1>

</div>

</header>

</div>

<legend>Contact information</legend>

<label class="control-label"

for="firstname">First name *</label>

</nlfirstname></div>

</div>

<label class="control-label"

for="lastname">Last name *</label>

</nllastname></div>

</div>

<label class="control-label"

for="email">Email *</label>

</nlemail></div>

</div>

<label class="control-label"

for="title">Job title</label>

</nltitle></div>

</div>

<legend>Company details</legend>

<label class="control-label"

for="companyname">Company name *</label>

</nlcompanyname></div>

</div>

<label class="control-label"

for="custentity7">Company size</label>

</nlcustentity7></div>

</div>

<label class="control-label"

for="city">City</label>

</nlcity></div>

</div>

<label class="control-label"

for="state">State *</label>

</nlstate></div>

</div>

<label class="control-label"

for="zipcode">Zip/postal code *</label>

</nlzipcode></div>

</div>

<label class="control-label"

for="country">Country</label>

</nlcountry></div>

</div>

<label class="control-label"

for="Comments">Comments</label>

</nlcomments></div>

</div>

</nlsubsidiary></div>

</div>

<button type="submit" class="btn btn-lg btn-

primary btn-block">Submit form</button>

</div>

</form>

</div>

<hr>

<p class="pull-right">* Required fields</p>

<p>

</p>

</footer>

</div>

</body>

</html>