<![CDATA[
<form method="post" action="http://form.relevanttools.com/eis-cgi-bin/satellite">
<input type="hidden" name="code" value="7180"><input type="hidden" name="db" value="t1custom"><input type="hidden" name="source" value="T1 Customers"><input type="hidden" name="optin" value><input type="hidden" name="type" value="signup"><input type="hidden" name="user_email_msg" value="none"><input type="hidden" name="admin_email_addr" value="none"><input type="hidden" name="redir" value="http://www.t1-technologies.com/t1customers.html">
<table border="0">
<tr>
<td> </td>
<td>First Name</td>
<td> </td>
<td><input type="text" name="first_name" size="20" value></td>
</tr>
<tr>
<td> </td>
<td>Last Name</td>
<td> </td>
<td><input type="text" name="last_name" size="20" value></td>
</tr>
<tr>
<td> </td>
<td>Email*</td>
<td> </td>
<td><input type="text" name="email*" size="20" value></td>
</tr>
<tr>
<td> </td>
<td>Company</td>
<td> </td>
<td><input type="text" name="company" size="20" value></td>
</tr>
<tr>
<td> </td>
<td>Address</td>
<td> </td>
<td><input type="text" name="address" size="20" value></td>
</tr>
<tr>
<td> </td>
<td>City</td>
<td> </td>
<td><input type="text" name="city" size="20" value></td>
</tr>
<tr>
<td> </td>
<td>State</td>
<td> </td>
<td><select name="state">
<option value>Select
<option value="AL">AL
<option value="AK">AK
<option value="AS">AS
<option value="AZ">AZ
<option value="AR">AR
<option value="CA">CA
<option value="CO">CO
<option value="CT">CT
<option value="DE">DE
<option value="DC">DC
<option value="FM">FM
<option value="FL">FL
<option value="GA">GA
<option value="GU">GU
<option value="HI">HI
<option value="ID">ID
<option value="IL">IL
<option value="IN">IN
<option value="IA">IA
<option value="KS">KS
<option value="KY">KY
<option value="LA">LA
<option value="ME">ME
<option value="MH">MH
<option value="MD">MD
<option value="MA">MA
<option value="MI">MI
<option value="MN">MN
<option value="MS">MS
<option value="MO">MO
<option value="MT">MT
<option value="NE">NE
<option value="NV">NV
<option value="NH">NH
<option value="NJ">NJ
<option value="NM">NM
<option value="NY">NY
<option value="NC">NC
<option value="ND">ND
<option value="MP">MP
<option value="OH">OH
<option value="OK">OK
<option value="OR">OR
<option value="PW">PW
<option value="PA">PA
<option value="PR">PR
<option value="RI">RI
<option value="SC">SC
<option value="SD">SD
<option value="TN">TN
<option value="TX">TX
<option value="UT">UT
<option value="VT">VT
<option value="VI">VI
<option value="VA">VA
<option value="WA">WA
<option value="WV">WV
<option value="WI">WI
<option value="WY">WY
</select></td>
</tr>
<tr>
<td> </td>
<td>Zip</td>
<td> </td>
<td><input type="text" name="zip" size="20" value></td>
</tr>
<tr>
<td> </td>
<td>Country</td>
<td> </td>
<td><select name="country">
<option value>Select
<option value="United States of America">United States of America
<option value="Canada">Canada
<option value="Afghanistan">Afghanistan
<option value="Albania">Albania
<option value="Algeria">Algeria
<option value="American Samoa">American Samoa
<option value="Andorra">Andorra
<option value="Angola">Angola
<option value="Anguilla">Anguilla
<option value="Antarctica">Antarctica
<option value="Antigua and Barbuda">Antigua and Barbuda
<option value="Argentina">Argentina
<option value="Armenia">Armenia
<option value="Australia">Australia
<option value="Austria">Austria
<option value="Azerbaijan">Azerbaijan
<option value="Bahamas">Bahamas
<option value="Bahrain">Bahrain
<option value="Bangladesh">Bangladesh
<option value="Barbados">Barbados
<option value="Belarus">Belarus
<option value="Belgium">Belgium
<option value="Belize">Belize
<option value="Bermuda">Bermuda
<option value="Bhutan">Bhutan
<option value="Bolivia">Bolivia
<option value="Bosnia and Herzegowina">Bosnia and Herzegowina
<option value="Botswana">Botswana
<option value="Brazil">Brazil
<option value="Brunei Darussalam">Brunei Darussalam
<option value="Bulgaria">Bulgaria
<option value="Burkina Faso">Burkina Faso
<option value="Burundi">Burundi
<option value="Cambodia">Cambodia
<option value="Cameroon">Cameroon
<option value="Canada">Canada
<option value="Central African Republic">Central African Republic
<option value="Chad">Chad
<option value="Chile">Chile
<option value="China">China
<option value="Colombia">Colombia
<option value="Congo">Congo
<option value="Cook Islands">Cook Islands
<option value="Costa Rica">Costa Rica
<option value="Croatia (local name: Hrvatska)">Croatia (local name:
Hrvatska)
<option value="Cuba">Cuba
<option value="Cyprus">Cyprus
<option value="Czech Republic">Czech Republic
<option value="Denmark">Denmark
<option value="Djibouti">Djibouti
<option value="Dominica">Dominica
<option value="Dominican Republic">Dominican Republic
<option value="East Timor">East Timor
<option value="Ecuador">Ecuador
<option value="Egypt">Egypt
<option value="El Salvador">El Salvador
<option value="Equatorial Guinea">Equatorial Guinea
<option value="Eritrea">Eritrea
<option value="Estonia">Estonia
<option value="Ethiopia">Ethiopia
<option value="Fiji">Fiji
<option value="Finland">Finland
<option value="France">France
<option value="French Guiana">French Guiana
<option value="French Polynesia">French Polynesia
<option value="French Southern Territories">French Southern
Territories
<option value="Gabon">Gabon
<option value="Gambia">Gambia
<option value="Georgia">Georgia
<option value="Germany">Germany
<option value="Ghana">Ghana
<option value="Gibraltar">Gibraltar
<option value="Greece">Greece
<option value="Greenland">Greenland
<option value="Grenada">Grenada
<option value="Guadeloupe">Guadeloupe
<option value="Guam">Guam
<option value="Guatemala">Guatemala
<option value="Guinea">Guinea
<option value="Guinea-Bissau">Guinea-Bissau
<option value="Guyana">Guyana
<option value="Haiti">Haiti
<option value="Honduras">Honduras
<option value="Hong Kong">Hong Kong
<option value="Hungary">Hungary
<option value="Iceland">Iceland
<option value="India">India
<option value="Indonesia">Indonesia
<option value="Iran (Islamic Republic of)">Iran (Islamic Republic of)
<option value="Iraq">Iraq
<option value="Ireland">Ireland
<option value="Israel">Israel
<option value="Italy">Italy
<option value="Jamaica">Jamaica
<option value="Japan">Japan
<option value="Jordan">Jordan
<option value="Kazakhstan">Kazakhstan
<option value="Kenya">Kenya
<option value="Korea, Democratic Peoples Republic of">Korea,
Democratic Peoples Republic of
<option value="Korea, Republic of">Korea, Republic of
<option value="Kuwait">Kuwait
<option value="Kyrgyzstan">Kyrgyzstan
<option value="Lao Peoples Democratic Republic">Lao Peoples Democratic
Republic
<option value="Latvia">Latvia
<option value="Lebanon">Lebanon
<option value="Lesotho">Lesotho
<option value="Liberia">Liberia
<option value="Libyan Arab Jamahiriya">Libyan Arab Jamahiriya
<option value="Liechtenstein">Liechtenstein
<option value="Lithuania">Lithuania
<option value="Luxembourg">Luxembourg
<option value="Macau">Macau
<option value="Macedonia">Macedonia
<option value="Madagascar">Madagascar
<option value="Malawi">Malawi
<option value="Malaysia">Malaysia
<option value="Martinique">Martinique
<option value="Mauritania">Mauritania
<option value="Mauritius">Mauritius
<option value="Mexico">Mexico
<option value="Micronesia, Federated States Of">Micronesia, Federated
States Of
<option value="Moldova, Republic of">Moldova, Republic of
<option value="Monaco">Monaco
<option value="Mongolia">Mongolia
<option value="Morocco">Morocco
<option value="Mozambique">Mozambique
<option value="Namibia">Namibia
<option value="Nepal">Nepal
<option value="Netherlands">Netherlands
<option value="Netherlands Antilles">Netherlands Antilles
<option value="New Caledonia">New Caledonia
<option value="New Zealand">New Zealand
<option value="Nicaragua">Nicaragua
<option value="Niger">Niger
<option value="Nigeria">Nigeria
<option value="Norway">Norway
<option value="Oman">Oman
<option value="Pakistan">Pakistan
<option value="Panama">Panama
<option value="Papua New Guinea">Papua New Guinea
<option value="Paraguay">Paraguay
<option value="Peru">Peru
<option value="Philippines">Philippines
<option value="Poland">Poland
<option value="Portugal">Portugal
<option value="Puerto Rico">Puerto Rico
<option value="Romania">Romania
<option value="Russian Federation">Russian Federation
<option value="Rwanda">Rwanda
<option value="Samoa">Samoa
<option value="Saudi Arabia">Saudi Arabia
<option value="Senegal">Senegal
<option value="Seychelles">Seychelles
<option value="Sierra Leone">Sierra Leone
<option value="Singapore">Singapore
<option value="Slovakia (Slovak Republic)">Slovakia (Slovak Republic)
<option value="Slovenia">Slovenia
<option value="Somalia">Somalia
<option value="South Africa">South Africa
<option value="South Georgia">South Georgia
<option value="Spain">Spain
<option value="Sri Lanka">Sri Lanka
<option value="Sudan">Sudan
<option value="Suriname">Suriname
<option value="Swaziland">Swaziland
<option value="Sweden">Sweden
<option value="Switzerland">Switzerland
<option value="Syrian Arab Republic">Syrian Arab Republic
<option value="Taiwan">Taiwan
<option value="Tajikistan">Tajikistan
<option value="Tanzania, United Republic of">Tanzania, United Republic
of
<option value="Thailand">Thailand
<option value="Togo">Togo
<option value="Tonga">Tonga
<option value="Trinidad and Tobago">Trinidad and Tobago
<option value="Tunisia">Tunisia
<option value="Turkey">Turkey
<option value="Turkmenistan">Turkmenistan
<option value="Uganda">Uganda
<option value="Ukraine">Ukraine
<option value="United Arab Emirates">United Arab Emirates
<option value="United Kingdom">United Kingdom
<option value="United States of America">United States of America
<option value="Uruguay">Uruguay
<option value="Uzbekistan">Uzbekistan
<option value="Vatican City State (Holy See)">Vatican City State (Holy
See)
<option value="Venezuela">Venezuela
<option value="Viet Nam">Viet Nam
<option value="Virgin Islands (British)">Virgin Islands (British)
<option value="Virgin Islands (U.S.)">Virgin Islands (U.S.)
<option value="Western Sahara">Western Sahara
<option value="Yemen">Yemen
<option value="Yugoslavia">Yugoslavia
<option value="Zaire">Zaire
<option value="Zambia">Zambia
<option value="Zimbabwe">Zimbabwe
</select></td>
</tr>
<tr>
<td> </td>
<td>Phone</td>
<td> </td>
<td><input type="text" name="phone" size="20" value></td>
</tr>
<tr>
<td> </td>
<td>Fax</td>
<td> </td>
<td><input type="text" name="fax" size="20" value></td>
</tr>
<tr>
<td> </td>
<td>notes</td>
<td> </td>
<td><input type="text" name="Notes" size="20" value></td>
</tr>
<tr>
<td> </td>
<td> </td>
<td> </td>
<td><input type="submit" value="Submit"></td>
</tr>
</table>
</form>
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