Online Quote
<h2><font size="7" color="#485E8E" face="Berlin Sans FB Demi">Online Quote<br>
&nbsp;</font>

<table width="95%" cellpadding="0" cellspacing="0">
 <form action="takequote.php" method="post"><input type="hidden" name="PHPSESSID" value="116d45c7a909ed93a5dcbfdf575cae45" />   <tr>
 <td width="50%">

 <table cellpadding="0" cellspacing="0">
 <tr><td>
 Company Name:
 </td>
 <td>
 <input type="text" name="name" size="30"> </td></tr>
 <tr><td>
 Street Address:
 </td>
 <td>
 <input type="text" name="street" size="30"> </td></tr>
 <tr><td>
 City:
 </td>
 <td>
 <input type="text" name="city" size="30"> </td></tr>
 <tr><td>
 State:
 </td>
 <td>
 <input type="text" name="state" size="3"> </td></tr>
 <tr><td>
 Zip:
 </td>
 <td>
 <input type="text" name="zip" size="11"> </td></tr>
 </table>

 </td>
 <td width="50%">

 <table cellpadding="0" cellspacing="0">
 <tr><td>
 Contact Name:
 </td>
 <td>
 <input type="text" name="contact" size="30"> </td></tr>
 <tr><td>
 Contact Number:
 </td>
 <td>
 <input type="text" name="connum" size="12"> &nbsp;Ext:
 <input type="text" name="ext" size="5"> </td></tr>
 <tr><td>
 Fax:
 </td>
 <td>
 <input type="text" name="fax" size="12"> </td></tr>
 <tr><td>
 Contact Email:
 </td>
 <td>
 <input type="text" name="email" size="30"> </td></tr>
 </table>
 </td>
 </tr>
 </table>
<br><br>
<table width="95%" class="quotehead" cellpadding="0" cellspacing="0">
<tr>
<td class="quotehead"><b>LINE</b></td>
<td class="quotehead"><b>DESCRIPTION</b></td>
<td class="quotehead"><b>QTY</b></td>
</tr>
<tr>
  <td class="quotebody">1</td>
  <input type="hidden" name="item[1]" value="1">
  <td class="quotebody"><textarea name="desc[1]" cols="80" rows="3" style="padding: 4px"></textarea></td>
  <td class="quotebody"><input name="qty[1]" size="10"></td>
</tr>
<tr>
  <td class="quotebody">2</td>
  <input type="hidden" name="item[2]" value="2">
  <td class="quotebody"><textarea name="desc[2]" cols="80" rows="3" style="padding: 4px"></textarea></td>
  <td class="quotebody"><input name="qty[2]" size="10"></td>
</tr>
<tr>
  <td class="quotebody">3</td>
  <input type="hidden" name="item[3]" value="3">
  <td class="quotebody"><textarea name="desc[3]" cols="80" rows="3" style="padding: 4px"></textarea></td>
  <td class="quotebody"><input name="qty[3]" size="10"></td>
</tr>
<input type="hidden" value="23" name="qnum"><input type="hidden" value="1" name="page"> 
</table>
<table align="center">
<tr>
<td>
<input type="submit" value="Add More" name="button">
</td>
<td>
<input type="submit" value="Done" name="button">
</td>
</tr>
</table>
</form>