Outer Banks Blue Real Estate (230) -- OBX Blue Contacts (87)

Visual Data Systems

Queue Cleaned out for 0000059013

brochure - OBX Blue Request Brochure Form

FormID: 257 AccountID: 87

LEGACY Contents for config-brochure.php file:
<?php $AccountID = 87; $formid = 257; $navisdKW = 'Navis Follow Up Marketing'; $pageTitle = ''; $pageHeader = ''; $introText = ''; $template = $Root.'/Templates/page2.dwt'; $contactblock = "<tr><td colspan=4><table width=100%><tr><td align=right class=label>First Name:</td><td width=85%><input type='text' name='FirstName' value='".(($_POST['FirstName'] <> "") ? htmlentities(stripslashes($_POST['FirstName']), ENT_QUOTES) : "")."' size=24 maxlength=24 />$reqsymbol</td></tr> <tr><td align=right class=label>Last Name:</td><td width=85%><input type='text' name='LastName' value='".(($_POST['LastName'] <> "") ? htmlentities(stripslashes($_POST['LastName']), ENT_QUOTES) : "")."' size=32 maxlength=32 />$reqsymbol</td></tr> <tr><td align=right class=label>Email:</td><td width=85%><input type='text' name='Email' value='".(($_POST['Email'] <> "") ? htmlentities(stripslashes($_POST['Email']), ENT_QUOTES) : "")."' size=32 maxlength=64 />$reqsymbol</td></tr> <tr><td align=right class=label>Phone:</td><td width=85%><input type='text' name='Phone' value='".(($_POST['Phone'] <> "") ? htmlentities(stripslashes($_POST['Phone']), ENT_QUOTES) : "")."' size=16 maxlength=16 /></td></tr> <tr><td align=right class=label>Alternate Phone:</td><td width=85%><input type='text' name='Phone2' value='".(($_POST['Phone2'] <> "") ? htmlentities(stripslashes($_POST['Phone2']), ENT_QUOTES) : "")."' size=16 maxlength=16 /></td></tr> <tr><td align=right class=label>Address 1:</td><td width=85%><input type='text' name='Address1' value='".(($_POST['Address1'] <> "") ? htmlentities(stripslashes($_POST['Address1']), ENT_QUOTES) : "")."' size=44 maxlength=48 />$reqsymbol</td></tr> <tr><td align=right class=label>Address 2:</td><td width=85%><input type='text' name='Address2' value='".(($_POST['Address2'] <> "") ? htmlentities(stripslashes($_POST['Address2']), ENT_QUOTES) : "")."' size=44 maxlength=48 /></td></tr> <tr><td align=right class=label>City:</td><td width=85%><input type='text' name='City' value='".(($_POST['City'] <> "") ? htmlentities(stripslashes($_POST['City']), ENT_QUOTES) : "")."' size=24 maxlength=24 />$reqsymbol</td></tr> <tr><td align=right class=label>State:</td><td><select name='State' size='1'><option value='' SELECTED>[State]</option><option value='ZZ'".(($_POST['State'] == 'ZZ') ? "selected" : "").">International</option><option value='AL'".(($_POST['State'] == 'AL') ? "selected" : "").">AL-Alabama</option><option value='AK'".(($_POST['State'] == 'AK') ? "selected" : "").">AK-Alaska</option><option value='AZ'".(($_POST['State'] == 'AZ') ? "selected" : "").">AZ-Arizona</option><option value='AR'".(($_POST['State'] == 'AR') ? "selected" : "").">AR-Arkansas</option><option value='CA'".(($_POST['State'] == 'CA') ? "selected" : "").">CA-California</option><option value='CO'".(($_POST['State'] == 'CO') ? "selected" : "").">CO-Colorado</option><option value='CT'".(($_POST['State'] == 'CT') ? "selected" : "").">CT-Connecticut</option><option value='DC'".(($_POST['State'] == 'DC') ? "selected" : "").">DC-Washington D.C.</option><option value='DE'".(($_POST['State'] == 'DE') ? "selected" : "").">DE-Delaware</option><option value='FL'".(($_POST['State'] == 'FL') ? "selected" : "").">FL-Florida</option><option value='GA'".(($_POST['State'] == 'GA') ? "selected" : "").">GA-Georgia</option><option value='HI'".(($_POST['State'] == 'HI') ? "selected" : "").">HI-Hawaii</option><option value='ID'".(($_POST['State'] == 'ID') ? "selected" : "").">ID-Idaho</option><option value='IL'".(($_POST['State'] == 'IL') ? "selected" : "").">IL-Illinois</option><option value='IN'".(($_POST['State'] == 'IN') ? "selected" : "").">IN-Indiana</option><option value='IA'".(($_POST['State'] == 'IA') ? "selected" : "").">IA-Iowa</option><option value='KS'".(($_POST['State'] == 'KS') ? "selected" : "").">KS-Kansas</option><option value='KY'".(($_POST['State'] == 'KY') ? "selected" : "").">KY-Kentucky</option><option value='LA'".(($_POST['State'] == 'LA') ? "selected" : "").">LA-Louisiana</option><option value='ME'".(($_POST['State'] == 'ME') ? "selected" : "").">ME-Maine</option><option value='MD'".(($_POST['State'] == 'MD') ? "selected" : "").">MD-Maryland</option><option value='MA'".(($_POST['State'] == 'MA') ? "selected" : "").">MA-Massachusetts</option><option value='MI'".(($_POST['State'] == 'MI') ? "selected" : "").">MI-Michigan</option><option value='MN'".(($_POST['State'] == 'MN') ? "selected" : "").">MN-Minnesota</option><option value='MS'".(($_POST['State'] == 'MS') ? "selected" : "").">MS-Mississippi</option><option value='MO'".(($_POST['State'] == 'MO') ? "selected" : "").">MO-Missouri</option><option value='MT'".(($_POST['State'] == 'MT') ? "selected" : "").">MT-Montana</option><option value='NE'".(($_POST['State'] == 'NE') ? "selected" : "").">NE-Nebraska</option><option value='NV'".(($_POST['State'] == 'NV') ? "selected" : "").">NV-Nevada</option><option value='NH'".(($_POST['State'] == 'NH') ? "selected" : "").">NH-New Hampshire</option><option value='NJ'".(($_POST['State'] == 'NJ') ? "selected" : "").">NJ-New Jersey</option><option value='NM'".(($_POST['State'] == 'NM') ? "selected" : "").">NM-New Mexico</option><option value='NY'".(($_POST['State'] == 'NY') ? "selected" : "").">NY-New York</option><option value='NC'".(($_POST['State'] == 'NC') ? "selected" : "").">NC-North Carolina</option><option value='ND'".(($_POST['State'] == 'ND') ? "selected" : "").">ND-North Dakota</option><option value='OH'".(($_POST['State'] == 'OH') ? "selected" : "").">OH-Ohio</option><option value='OK'".(($_POST['State'] == 'OK') ? "selected" : "").">OK-Oklahoma</option><option value='OR'".(($_POST['State'] == 'OR') ? "selected" : "").">OR-Oregon</option><option value='PA'".(($_POST['State'] == 'PA') ? "selected" : "").">PA-Pennsylvania</option><option value='PR'".(($_POST['State'] == 'PR') ? "selected" : "").">PR-Puerto Rico</option><option value='RI'".(($_POST['State'] == 'RI') ? "selected" : "").">RI-Rhode Island</option><option value='SC'".(($_POST['State'] == 'SC') ? "selected" : "").">SC-South Carolina</option><option value='SD'".(($_POST['State'] == 'SD') ? "selected" : "").">SD-South Dakota</option><option value='TN'".(($_POST['State'] == 'TN') ? "selected" : "").">TN-Tennessee</option><option value='TX'".(($_POST['State'] == 'TX') ? "selected" : "").">TX-Texas</option><option value='UT'".(($_POST['State'] == 'UT') ? "selected" : "").">UT-Utah</option><option value='VT'".(($_POST['State'] == 'VT') ? "selected" : "").">VT-Vermont</option><option value='VA'".(($_POST['State'] == 'VA') ? "selected" : "").">VA-Virginia</option><option value='WA'".(($_POST['State'] == 'WA') ? "selected" : "").">WA-Washington</option><option value='WV'".(($_POST['State'] == 'WV') ? "selected" : "").">WV-West Virginia</option><option value='WI'".(($_POST['State'] == 'WI') ? "selected" : "").">WI-Wisconsin</option><option value='WY'".(($_POST['State'] == 'WY') ? "selected" : "").">WY-Wyoming</option></select>$reqsymbol</td></tr> <tr><td align=right class=label>Zip:</td><td width=85%><input type='text' name='Zip' value='".(($_POST['Zip'] <> "") ? htmlentities(stripslashes($_POST['Zip']), ENT_QUOTES) : "")."' size=10 maxlength=10 />$reqsymbol</td></tr> <tr><td align=right class=label>Country:</td><td><select name='Country' size='1'><option value='' SELECTED>[Country]</option><option value='United States'".(($_POST['Country'] == 'United States') ? "selected" : "").">United States</option><option value='Canada'".(($_POST['Country'] == 'Canada') ? "selected" : "").">Canada</option><option value='Afghanistan'".(($_POST['Country'] == 'Afghanistan') ? "selected" : "").">Afghanistan</option><option value='Albania'".(($_POST['Country'] == 'Albania') ? "selected" : "").">Albania</option><option value='Algeria'".(($_POST['Country'] == 'Algeria') ? "selected" : "").">Algeria</option><option value='American Samoa'".(($_POST['Country'] == 'American Samoa') ? "selected" : "").">American Samoa</option><option value='Andorra'".(($_POST['Country'] == 'Andorra') ? "selected" : "").">Andorra</option><option value='Angola'".(($_POST['Country'] == 'Angola') ? "selected" : "").">Angola</option><option value='Anguilla'".(($_POST['Country'] == 'Anguilla') ? "selected" : "").">Anguilla</option><option value='Antarctica'".(($_POST['Country'] == 'Antarctica') ? "selected" : "").">Antarctica</option><option value='Antigua And Barbuda'".(($_POST['Country'] == 'Antigua And Barbuda') ? "selected" : "").">Antigua And Barbuda</option><option value='Argentina'".(($_POST['Country'] == 'Argentina') ? "selected" : "").">Argentina</option><option value='Armenia'".(($_POST['Country'] == 'Armenia') ? "selected" : "").">Armenia</option><option value='Aruba'".(($_POST['Country'] == 'Aruba') ? "selected" : "").">Aruba</option><option value='Australia'".(($_POST['Country'] == 'Australia') ? "selected" : "").">Australia</option><option value='Austria'".(($_POST['Country'] == 'Austria') ? "selected" : "").">Austria</option><option value='Azerbaijan'".(($_POST['Country'] == 'Azerbaijan') ? "selected" : "").">Azerbaijan</option><option value='Bahamas'".(($_POST['Country'] == 'Bahamas') ? "selected" : "").">Bahamas</option><option value='Bahrain'".(($_POST['Country'] == 'Bahrain') ? "selected" : "").">Bahrain</option><option value='Bangladesh'".(($_POST['Country'] == 'Bangladesh') ? "selected" : "").">Bangladesh</option><option value='Barbados'".(($_POST['Country'] == 'Barbados') ? "selected" : "").">Barbados</option><option value='Belarus'".(($_POST['Country'] == 'Belarus') ? "selected" : "").">Belarus</option><option value='Belgium'".(($_POST['Country'] == 'Belgium') ? "selected" : "").">Belgium</option><option value='Belize'".(($_POST['Country'] == 'Belize') ? "selected" : "").">Belize</option><option value='Benin'".(($_POST['Country'] == 'Benin') ? "selected" : "").">Benin</option><option value='Bermuda'".(($_POST['Country'] == 'Bermuda') ? "selected" : "").">Bermuda</option><option value='Bhutan'".(($_POST['Country'] == 'Bhutan') ? "selected" : "").">Bhutan</option><option value='Bolivia'".(($_POST['Country'] == 'Bolivia') ? "selected" : "").">Bolivia</option><option value='Bosnia And Herzegowina'".(($_POST['Country'] == 'Bosnia And Herzegowina') ? "selected" : "").">Bosnia And Herzegowina</option><option value='Botswana'".(($_POST['Country'] == 'Botswana') ? "selected" : "").">Botswana</option><option value='Bouvet Island'".(($_POST['Country'] == 'Bouvet Island') ? "selected" : "").">Bouvet Island</option><option value='Brazil'".(($_POST['Country'] == 'Brazil') ? "selected" : "").">Brazil</option><option value='British Indian Ocean Territory'".(($_POST['Country'] == 'British Indian Ocean Territory') ? "selected" : "").">British Indian Ocean Territory</option><option value='Brunei Darussalam'".(($_POST['Country'] == 'Brunei Darussalam') ? "selected" : "").">Brunei Darussalam</option><option value='Bulgaria'".(($_POST['Country'] == 'Bulgaria') ? "selected" : "").">Bulgaria</option><option value='Burkina Faso'".(($_POST['Country'] == 'Burkina Faso') ? "selected" : "").">Burkina Faso</option><option value='Burundi'".(($_POST['Country'] == 'Burundi') ? "selected" : "").">Burundi</option><option value='Cambodia'".(($_POST['Country'] == 'Cambodia') ? "selected" : "").">Cambodia</option><option value='Cameroon'".(($_POST['Country'] == 'Cameroon') ? "selected" : "").">Cameroon</option><option value='Canada'".(($_POST['Country'] == 'Canada') ? "selected" : "").">Canada</option><option value='Cape Verde'".(($_POST['Country'] == 'Cape Verde') ? "selected" : "").">Cape Verde</option><option value='Cayman Islands'".(($_POST['Country'] == 'Cayman Islands') ? "selected" : "").">Cayman Islands</option><option value='Central African Republic'".(($_POST['Country'] == 'Central African Republic') ? "selected" : "").">Central African Republic</option><option value='Chad'".(($_POST['Country'] == 'Chad') ? "selected" : "").">Chad</option><option value='Chile'".(($_POST['Country'] == 'Chile') ? "selected" : "").">Chile</option><option value='China'".(($_POST['Country'] == 'China') ? "selected" : "").">China</option><option value='Christmas Island'".(($_POST['Country'] == 'Christmas Island') ? "selected" : "").">Christmas Island</option><option value='Cocos (Keeling) Islands'".(($_POST['Country'] == 'Cocos (Keeling) Islands') ? "selected" : "").">Cocos (Keeling) Islands</option><option value='Colombia'".(($_POST['Country'] == 'Colombia') ? "selected" : "").">Colombia</option><option value='Comoros'".(($_POST['Country'] == 'Comoros') ? "selected" : "").">Comoros</option><option value='Congo'".(($_POST['Country'] == 'Congo') ? "selected" : "").">Congo</option><option value='Cook Islands'".(($_POST['Country'] == 'Cook Islands') ? "selected" : "").">Cook Islands</option><option value='Costa Rica'".(($_POST['Country'] == 'Costa Rica') ? "selected" : "").">Costa Rica</option><option value='Cote D\'Ivoire'".(($_POST['Country'] == 'Cote D\'Ivoire') ? "selected" : "").">Cote D\'Ivoire</option><option value='Croatia'".(($_POST['Country'] == 'Croatia') ? "selected" : "").">Croatia</option><option value='Cuba'".(($_POST['Country'] == 'Cuba') ? "selected" : "").">Cuba</option><option value='Cyprus'".(($_POST['Country'] == 'Cyprus') ? "selected" : "").">Cyprus</option><option value='Czech Republic'".(($_POST['Country'] == 'Czech Republic') ? "selected" : "").">Czech Republic</option><option value='Denmark'".(($_POST['Country'] == 'Denmark') ? "selected" : "").">Denmark</option><option value='Djibouti'".(($_POST['Country'] == 'Djibouti') ? "selected" : "").">Djibouti</option><option value='Dominica'".(($_POST['Country'] == 'Dominica') ? "selected" : "").">Dominica</option><option value='Dominican Republic'".(($_POST['Country'] == 'Dominican Republic') ? "selected" : "").">Dominican Republic</option><option value='East Timor'".(($_POST['Country'] == 'East Timor') ? "selected" : "").">East Timor</option><option value='Ecuador'".(($_POST['Country'] == 'Ecuador') ? "selected" : "").">Ecuador</option><option value='Egypt'".(($_POST['Country'] == 'Egypt') ? "selected" : "").">Egypt</option><option value='El Salvador'".(($_POST['Country'] == 'El Salvador') ? "selected" : "").">El Salvador</option><option value='Equatorial Guinea'".(($_POST['Country'] == 'Equatorial Guinea') ? "selected" : "").">Equatorial Guinea</option><option value='Eritrea'".(($_POST['Country'] == 'Eritrea') ? "selected" : "").">Eritrea</option><option value='Estonia'".(($_POST['Country'] == 'Estonia') ? "selected" : "").">Estonia</option><option value='Ethiopia'".(($_POST['Country'] == 'Ethiopia') ? "selected" : "").">Ethiopia</option><option value='Falkland Islands'".(($_POST['Country'] == 'Falkland Islands') ? "selected" : "").">Falkland Islands</option><option value='Faroe Islands'".(($_POST['Country'] == 'Faroe Islands') ? "selected" : "").">Faroe Islands</option><option value='Fiji'".(($_POST['Country'] == 'Fiji') ? "selected" : "").">Fiji</option><option value='Finland'".(($_POST['Country'] == 'Finland') ? "selected" : "").">Finland</option><option value='France'".(($_POST['Country'] == 'France') ? "selected" : "").">France</option><option value='France, Metropolitan'".(($_POST['Country'] == 'France, Metropolitan') ? "selected" : "").">France, Metropolitan</option><option value='French Guiana'".(($_POST['Country'] == 'French Guiana') ? "selected" : "").">French Guiana</option><option value='French Polynesia'".(($_POST['Country'] == 'French Polynesia') ? "selected" : "").">French Polynesia</option><option value='French Southern Territories'".(($_POST['Country'] == 'French Southern Territories') ? "selected" : "").">French Southern Territories</option><option value='Gabon'".(($_POST['Country'] == 'Gabon') ? "selected" : "").">Gabon</option><option value='Gambia'".(($_POST['Country'] == 'Gambia') ? "selected" : "").">Gambia</option><option value='Georgia'".(($_POST['Country'] == 'Georgia') ? "selected" : "").">Georgia</option><option value='Germany'".(($_POST['Country'] == 'Germany') ? "selected" : "").">Germany</option><option value='Ghana'".(($_POST['Country'] == 'Ghana') ? "selected" : "").">Ghana</option><option value='Gibraltar'".(($_POST['Country'] == 'Gibraltar') ? "selected" : "").">Gibraltar</option><option value='Greece'".(($_POST['Country'] == 'Greece') ? "selected" : "").">Greece</option><option value='Greenland'".(($_POST['Country'] == 'Greenland') ? "selected" : "").">Greenland</option><option value='Grenada'".(($_POST['Country'] == 'Grenada') ? "selected" : "").">Grenada</option><option value='Guadeloupe'".(($_POST['Country'] == 'Guadeloupe') ? "selected" : "").">Guadeloupe</option><option value='Guam'".(($_POST['Country'] == 'Guam') ? "selected" : "").">Guam</option><option value='Guatemala'".(($_POST['Country'] == 'Guatemala') ? "selected" : "").">Guatemala</option><option value='Guinea'".(($_POST['Country'] == 'Guinea') ? "selected" : "").">Guinea</option><option value='Guinea-Bissau'".(($_POST['Country'] == 'Guinea-Bissau') ? "selected" : "").">Guinea-Bissau</option><option value='Guyana'".(($_POST['Country'] == 'Guyana') ? "selected" : "").">Guyana</option><option value='Haiti'".(($_POST['Country'] == 'Haiti') ? "selected" : "").">Haiti</option><option value='Heard And Mc Donald Islands'".(($_POST['Country'] == 'Heard And Mc Donald Islands') ? "selected" : "").">Heard And Mc Donald Islands</option><option value='Honduras'".(($_POST['Country'] == 'Honduras') ? "selected" : "").">Honduras</option><option value='Hong Kong'".(($_POST['Country'] == 'Hong Kong') ? "selected" : "").">Hong Kong</option><option value='Hungary'".(($_POST['Country'] == 'Hungary') ? "selected" : "").">Hungary</option><option value='Iceland'".(($_POST['Country'] == 'Iceland') ? "selected" : "").">Iceland</option><option value='India'".(($_POST['Country'] == 'India') ? "selected" : "").">India</option><option value='Indonesia'".(($_POST['Country'] == 'Indonesia') ? "selected" : "").">Indonesia</option><option value='Iran'".(($_POST['Country'] == 'Iran') ? "selected" : "").">Iran</option><option value='Iraq'".(($_POST['Country'] == 'Iraq') ? "selected" : "").">Iraq</option><option value='Ireland'".(($_POST['Country'] == 'Ireland') ? "selected" : "").">Ireland</option><option value='Israel'".(($_POST['Country'] == 'Israel') ? "selected" : "").">Israel</option><option value='Italy'".(($_POST['Country'] == 'Italy') ? "selected" : "").">Italy</option><option value='Jamaica'".(($_POST['Country'] == 'Jamaica') ? "selected" : "").">Jamaica</option><option value='Japan'".(($_POST['Country'] == 'Japan') ? "selected" : "").">Japan</option><option value='Jordan'".(($_POST['Country'] == 'Jordan') ? "selected" : "").">Jordan</option><option value='Kazakhstan'".(($_POST['Country'] == 'Kazakhstan') ? "selected" : "").">Kazakhstan</option><option value='Kenya'".(($_POST['Country'] == 'Kenya') ? "selected" : "").">Kenya</option><option value='Kiribati'".(($_POST['Country'] == 'Kiribati') ? "selected" : "").">Kiribati</option><option value='North Korea (People\'s Republic Of Korea)'".(($_POST['Country'] == 'North Korea (People\'s Republic Of Korea)') ? "selected" : "").">North Korea (People\'s Republic Of Korea)</option><option value='South Korea (Republic Of Korea)'".(($_POST['Country'] == 'South Korea (Republic Of Korea)') ? "selected" : "").">South Korea (Republic Of Korea)</option><option value='Kuwait'".(($_POST['Country'] == 'Kuwait') ? "selected" : "").">Kuwait</option><option value='Kyrgyzstan'".(($_POST['Country'] == 'Kyrgyzstan') ? "selected" : "").">Kyrgyzstan</option><option value='Lao People\'s Republic'".(($_POST['Country'] == 'Lao People\'s Republic') ? "selected" : "").">Lao People\'s Republic</option><option value='Latvia'".(($_POST['Country'] == 'Latvia') ? "selected" : "").">Latvia</option><option value='Lebanon'".(($_POST['Country'] == 'Lebanon') ? "selected" : "").">Lebanon</option><option value='Lesotho'".(($_POST['Country'] == 'Lesotho') ? "selected" : "").">Lesotho</option><option value='Liberia'".(($_POST['Country'] == 'Liberia') ? "selected" : "").">Liberia</option><option value='Libyan Arab Jamahiriya'".(($_POST['Country'] == 'Libyan Arab Jamahiriya') ? "selected" : "").">Libyan Arab Jamahiriya</option><option value='Liechtenstein'".(($_POST['Country'] == 'Liechtenstein') ? "selected" : "").">Liechtenstein</option><option value='Lithuania'".(($_POST['Country'] == 'Lithuania') ? "selected" : "").">Lithuania</option><option value='Luxembourg'".(($_POST['Country'] == 'Luxembourg') ? "selected" : "").">Luxembourg</option><option value='Macau'".(($_POST['Country'] == 'Macau') ? "selected" : "").">Macau</option><option value='Macedonia'".(($_POST['Country'] == 'Macedonia') ? "selected" : "").">Macedonia</option><option value='Madagascar'".(($_POST['Country'] == 'Madagascar') ? "selected" : "").">Madagascar</option><option value='Malawi'".(($_POST['Country'] == 'Malawi') ? "selected" : "").">Malawi</option><option value='Malaysia'".(($_POST['Country'] == 'Malaysia') ? "selected" : "").">Malaysia</option><option value='Maldives'".(($_POST['Country'] == 'Maldives') ? "selected" : "").">Maldives</option><option value='Mali'".(($_POST['Country'] == 'Mali') ? "selected" : "").">Mali</option><option value='Malta'".(($_POST['Country'] == 'Malta') ? "selected" : "").">Malta</option><option value='Marshall Islands'".(($_POST['Country'] == 'Marshall Islands') ? "selected" : "").">Marshall Islands</option><option value='Martinique'".(($_POST['Country'] == 'Martinique') ? "selected" : "").">Martinique</option><option value='Mauritania'".(($_POST['Country'] == 'Mauritania') ? "selected" : "").">Mauritania</option><option value='Mauritius'".(($_POST['Country'] == 'Mauritius') ? "selected" : "").">Mauritius</option><option value='Mayotte'".(($_POST['Country'] == 'Mayotte') ? "selected" : "").">Mayotte</option><option value='Mexico'".(($_POST['Country'] == 'Mexico') ? "selected" : "").">Mexico</option><option value='Micronesia'".(($_POST['Country'] == 'Micronesia') ? "selected" : "").">Micronesia</option><option value='Moldova'".(($_POST['Country'] == 'Moldova') ? "selected" : "").">Moldova</option><option value='Monaco'".(($_POST['Country'] == 'Monaco') ? "selected" : "").">Monaco</option><option value='Mongolia'".(($_POST['Country'] == 'Mongolia') ? "selected" : "").">Mongolia</option><option value='Montserrat'".(($_POST['Country'] == 'Montserrat') ? "selected" : "").">Montserrat</option><option value='Morocco'".(($_POST['Country'] == 'Morocco') ? "selected" : "").">Morocco</option><option value='Mozambique'".(($_POST['Country'] == 'Mozambique') ? "selected" : "").">Mozambique</option><option value='Myanmar'".(($_POST['Country'] == 'Myanmar') ? "selected" : "").">Myanmar</option><option value='Namibia'".(($_POST['Country'] == 'Namibia') ? "selected" : "").">Namibia</option><option value='Nauru'".(($_POST['Country'] == 'Nauru') ? "selected" : "").">Nauru</option><option value='Nepal'".(($_POST['Country'] == 'Nepal') ? "selected" : "").">Nepal</option><option value='Netherlands'".(($_POST['Country'] == 'Netherlands') ? "selected" : "").">Netherlands</option><option value='Netherlands Antilles'".(($_POST['Country'] == 'Netherlands Antilles') ? "selected" : "").">Netherlands Antilles</option><option value='New Caledonia'".(($_POST['Country'] == 'New Caledonia') ? "selected" : "").">New Caledonia</option><option value='New Zealand'".(($_POST['Country'] == 'New Zealand') ? "selected" : "").">New Zealand</option><option value='Nicaragua'".(($_POST['Country'] == 'Nicaragua') ? "selected" : "").">Nicaragua</option><option value='Niger'".(($_POST['Country'] == 'Niger') ? "selected" : "").">Niger</option><option value='Nigeria'".(($_POST['Country'] == 'Nigeria') ? "selected" : "").">Nigeria</option><option value='Niue'".(($_POST['Country'] == 'Niue') ? 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"selected":"").">Pinterest</option><option value='0000052367' ".(($_POST['MAID:0000000693'] == '0000052367') ? "selected":"").">LinkedIn</option><option value='0000052368' ".(($_POST['MAID:0000000693'] == '0000052368') ? "selected":"").">Twitter</option><option value='0000052369' ".(($_POST['MAID:0000000693'] == '0000052369') ? "selected":"").">Youtube</option></select></td></tr> <tr><td colspan=2><input type='checkbox' class=clear name='MAID:0000002104' value='0000039872' CHECKED /><b>Please contact me via email to annouce rate reductions and special events.</b></td></tr> <tr><td class=label colspan=2><b>Please Indicate any special interests:</b></td></tr><tr><td>   <input type='checkbox' class=clear name='MAID:0000000694:0' value='0000033064' ".(($_POST['MAID:0000000694:0'] == '0000033064') ? "checked='checked'":"")." />Fishing </td><td>   <input type='checkbox' class=clear name='MAID:0000000694:1' value='0000033065' ".(($_POST['MAID:0000000694:1'] == '0000033065') ? "checked='checked'":"")." />First Flight Annual Celebration </td></tr><tr><td>   <input type='checkbox' class=clear name='MAID:0000000694:2' value='0000033066' ".(($_POST['MAID:0000000694:2'] == '0000033066') ? "checked='checked'":"")." />Outer Banks Marathon </td><td>   <input type='checkbox' class=clear name='MAID:0000000694:3' value='0000033067' ".(($_POST['MAID:0000000694:3'] == '0000033067') ? "checked='checked'":"")." />Wings Over Water (Birdwatching Festival) </td></tr><tr><td>   <input type='checkbox' class=clear name='MAID:0000000694:4' value='0000033068' ".(($_POST['MAID:0000000694:4'] == '0000033068') ? "checked='checked'":"")." />Surfing </td> <tr><td><b>What is your preferred property location?</b></td><td><select class='item' name='MAID:0000000695' size='1'><option value='0000033303' ".(($_POST['MAID:0000000695'] == '0000033303') ? "selected":"").">-select one-</option><option value='0000033069' ".(($_POST['MAID:0000000695'] == '0000033069') ? "selected":"").">Between the Highways</option><option value='0000033070' ".(($_POST['MAID:0000000695'] == '0000033070') ? "selected":"").">Ocean Front</option><option value='0000033071' ".(($_POST['MAID:0000000695'] == '0000033071') ? "selected":"").">Ocean Side</option><option value='0000033072' ".(($_POST['MAID:0000000695'] == '0000033072') ? "selected":"").">Ocean View</option><option value='0000033073' ".(($_POST['MAID:0000000695'] == '0000033073') ? "selected":"").">Semi Ocean Front</option><option value='0000033074' ".(($_POST['MAID:0000000695'] == '0000033074') ? "selected":"").">Sound Front</option><option value='0000033075' ".(($_POST['MAID:0000000695'] == '0000033075') ? "selected":"").">Sound Side</option></select></td></tr> <tr><td class=label colspan=2><b>Besides Summer, what other time of year would you consider vacationing in the Outer Banks?</b></td></tr><tr><td>   <input type='checkbox' class=clear name='MAID:0000001751:0' value='0000038090' ".(($_POST['MAID:0000001751:0'] == '0000038090') ? "checked='checked'":"")." />Fall </td><td>   <input type='checkbox' class=clear name='MAID:0000001751:1' value='0000038091' ".(($_POST['MAID:0000001751:1'] == '0000038091') ? "checked='checked'":"")." />Winter </td></tr><tr><td>   <input type='checkbox' class=clear name='MAID:0000001751:2' value='0000038092' ".(($_POST['MAID:0000001751:2'] == '0000038092') ? "checked='checked'":"")." />Spring </td><td>   <input type='checkbox' class=clear name='MAID:0000001751:3' value='0000038093' ".(($_POST['MAID:0000001751:3'] == '0000038093') ? "checked='checked'":"")." />None of the above </td></tr> <tr><td colspan=2><input type='checkbox' class=clear name='MAID:0000002105' value='0000039873' CHECKED /><b>Please send your current brochure.</b></td></tr> <tr><td colspan=2><b>How may we help you?</b></td></tr><tr><td colspan=2><textarea cols=60 rows=5 name='TEXT:0000000494'>".(($_POST['TEXT:0000000494'] <> "") ? htmlentities(stripslashes($_POST['TEXT:0000000494']), ENT_QUOTES) : htmlentities(stripslashes($altMessage), ENT_QUOTES))."</textarea></td></tr> "; $thanksTitle = ''; $thanksHeader = ''; $thanksText = '';