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<td colspan="2"><img src="images/1x1gray.gif" width="100%" height="1" align="top"></td>
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<td colspan="2"><strong>Findaflorist Order Form and Terms of Service Internet co-op Advertising Program</p></td>
</tr>
</table></td>
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<td><span id="lblTelefloraId" class="error"></span><span id="lblOtherDeliveryReport" class="error"></span><span id="lblMainPhoneNumber" class="error"></span><span id="lblTollFreeNumber" class="error"></span><span id="lblFaxNumber" class="error"></span></td>
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<table width="100%">
<tr>
<td align="right"><font color="red">* </font><strong>Shop Name</strong></td>
<td>
<input name="txtShopName" id="txtShopName" type="text" tabIndex="1" onchange="javascript:clearSuccessMessage();" autocomplete="off" /></td>
<td align="right"><font color="red">* </font><strong>Teleflora ID#</strong></td>
<td>
<input name="txtTelefloraID" id="txtTelefloraID" type="text" tabIndex="2" maxlength="8" onchange="javascript:clearSuccessMessage();" size="6" autocomplete="off" /></td>
</tr>
<tr class="dark">
<td align="right"><font color="red">* </font><strong>Teleflora Marketing<br>Counselor</strong></td>
<td>
<input name="txtMarketingCounselor" id="txtMarketingCounselor" type="text" tabIndex="1" onchange="javascript:clearSuccessMessage();" autocomplete="off" /></td>
<td align="right"> </td>
<td> </td>
</tr>
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</tr>
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<tr>
<td>
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<td>
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</tr>
<tr>
<td align="right"><font color="red">* </font>Address</td>
<td>
<input name="txtAddress" id="txtAddress" type="text" tabIndex="3" maxlength="250" autocomplete="on" /></td>
<td align="right"> Phone</td>
<td>
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<input name="mainPhoneNumber:phoneNumberPart2" id="mainPhoneNumber_phoneNumberPart2" type="text" maxlength="3" size="1" onKeyUp="return autoTab(this, 3, event);" autocomplete="off" />- </td>
<td>
<input name="mainPhoneNumber:phoneNumberPart3" id="mainPhoneNumber_phoneNumberPart3" type="text" maxlength="4" size="2" onKeyUp="return autoTab(this, 4, event);" autocomplete="off" /></td>
</tr>
</table></td>
</tr>
<tr>
<td align="right"><font color="red">* </font>City</td>
<td>
<input name="txtCity" id="txtCity" type="text" tabIndex="4" maxlength="50" autocomplete="on" /></td>
<td align="right"> Toll-Free Phone</td>
<td>
<head>
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<input name="TollFreeNumber:phoneNumberPart3" id="TollFreeNumber_phoneNumberPart3" type="text" maxlength="4" size="2" onKeyUp="return autoTab(this, 4, event);" autocomplete="off" /></td>
</tr>
</table></td>
</tr>
<tr>
<td align="right"><font color="red">* </font>State/Providence</td>
<td>
<input name="txtState" id="txtState" type="text" tabIndex="5" maxlength="50" autocomplete="on" /></td>
<td align="right"> Fax</td>
<td>
<head>
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<input name="FaxNumber:phoneNumberPart3" id="FaxNumber_phoneNumberPart3" type="text" maxlength="4" size="2" onKeyUp="return autoTab(this, 4, event);" autocomplete="off" /></td>
</tr>
</table>
</td>
</tr>
<tr>
<td align="right"><font color="red">* </font>Postal Code</td>
<td><input name="txtZip" id="txtZip" type="text" tabIndex="6" maxlength="10" size="8" autocomplete="on" /></td>
<td align="right"> E-Mail</td>
<td><input name="txtEmail" id="txtEmail" type="text" tabIndex="10" maxlength="40" autocomplete="on" /></td>
</tr>
<tr>
<td align="right"><font color="red">* </font>Country</td>
<td colspan="3">
<select name="ddlCountry" id="ddlCountry">
<option selected="selected" value="USA">USA</option>
<option value="Canada">Canada</option>
</select></td>
</tr>
</table>
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td>
<table class="light" bordercolor="#009900" cellspacing="0" cellpadding="0" width="100%" border="1">
<tr>
<td>
<table class="c10" cellspacing="0" cellpadding="5" width="100%" border="0">
<tr><form action="">
<td align="right"><strong>Packages:</strong></td>
<td align="right"><input value="yes, use existing" name="web_address" id="radioExistingUrl" type="radio" style="VERTICAL-ALIGN: middle" /></td>
<td>Gold</td>
<td align="right"><input value="yes, use existing" name="web_address" id="radioExistingUrl" type="radio" style="VERTICAL-ALIGN: middle" /></td>
<td>Platinum</td>
</tr></form>
<tr><form action="">
<td align="right"><strong>Commitment:</strong></td>
<td align="right"><input value="yes, use existing" name="web_address" id="radioExistingUrl" type="radio" style="VERTICAL-ALIGN: middle" /></td>
<td>6 months</td>
<td align="right"><input value="yes, use existing" name="web_address" id="radioExistingUrl" type="radio" style="VERTICAL-ALIGN: middle" /></td>
<td>12 months</td>
</tr></form>
</table>
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td>
<table class="light" bordercolor="#009900" cellspacing="0" cellpadding="0" width="100%" border="1">
<tr>
<td>
<table class="light" cellspacing="0" cellpadding="5" width="100%" bgcolor="#e7e7e7" border="0">
<tr>
<td colspan="2"><strong>ASBs City Listings:</strong> Choose 3 for Gold members and 6 for Platinum members. Resident shop must be within 20 miles of selected cities and must deliver to those cities.</td>
</tr>
<tr valign="top">
<td align="center">Select 3 Gold Members<form>
<select name="enchantment_color" id="enchantment_color" multiple>
<option disabled value ="-">----------------------------------</option>
<option value="Gold">Gold</option>
<option value="tangerine">Tangerine</option>
<option value="rose">Rose</option>
<option value="Gold">Gold</option>
<option value="tangerine">Tangerine</option>
<option value="rose">Rose</option>
</select></td></form>
<td align="center">Select 6 Platinum Members<form>
<select name="enchantment_color" id="enchantment_color" multiple>
<option disabled value ="-">----------------------------------</option>
<option value="Gold">Gold</option>
<option value="tangerine">Tangerine</option>
<option value="rose">Rose</option>
<option value="Gold">Gold</option>
<option value="tangerine">Tangerine</option>
<option value="rose">Rose</option>
</select></td></form>
<td align="center"><nobr>Additional ASBs ($5 per additional ASB)</nobr><form>
<select name="enchantment_color" id="enchantment_color" multiple>
<option disabled value ="-">----------------------------------</option>
<option value="Gold">Gold</option>
<option value="tangerine">Tangerine</option>
<option value="rose">Rose</option>
<option value="Gold">Gold</option>
<option value="tangerine">Tangerine</option>
<option value="rose">Rose</option>
</select></td></form>
</tr>
<tr>
<td colspan="3">
<table class="light" cellspacing="0" cellpadding="5" width="100%" border="1" bordercolor="#000000" frame="box">
<tr>
<td>
<table class="light" cellspacing="0" cellpadding="5" width="100%" border="1">
<tr>
<th>Pricing</th>
<th>Gold Package</th>
<th>Platinum Package</th
</tr
<tr align="center" valign="middle">
<td>12 month</td>
<td>$16.99</td>
<td>$24.99</td>
</tr
<tr align="center" valign="middle">
<td>6 month</td>
<td>$19.99</td>
<td>$29.99</td>
</tr
<tr align="center" valign="middle">
<td>Shop nmae</td>
<td>X</td>
<td>X</td>
</tr
<tr align="center" valign="middle">
<td>Address</td>
<td>X</td>
<td>X</td>
</tr
<tr align="center" valign="middle">
<td>URL</td>
<td>X</td>
<td>X</td>
</tr
<tr align="center" valign="middle">
<td>Local phone number</td>
<td>X</td>
<td>X</td>
</tr
<tr align="center" valign="middle">
<td>Toll-free phone number</td>
<td>X</td>
<td>X</td>
</tr
<tr align="center" valign="middle">
<td>Store hours</td>
<td>X</td>
<td>X</td>
</tr
<tr align="center" valign="middle">
<td>Resident listing</td>
<td>X</td>
<td>X</td>
</tr
<tr align="center" valign="middle">
<td>ASB listings</td>
<td>3 FREE</td>
<td>6 FREE</td>
</tr
<tr align="center" valign="middle">
<td>Highlighted text</td>
<td>$10/city</td>
<td>included</td>
</tr>
</table>
</td>
</tr>
<tr>
<td>*eFlorist members have URL included at no charge. All other non-Teleflora hosted websites $40 per month per</td>
</tr>
</table>
</td>
</tr>
</table>
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td>
<table class="light" bordercolor="#009900" cellspacing="0" cellpadding="0" width="100%" border="1">
<tr>
<td>
<table class="light" cellspacing="0" cellpadding="5" width="100%" border="0">
<tr>
<td><strong>Highlighted Text:</strong><br />
To differentiate your shop from others in the area, please provide a short description of your services. You are limited to 3 lines of 40 characters each. Below is a sample description.
<p><strong>NOTE: THERE IS AN INCREMENTAL CHARGE FOR GOLD MEMBERS SELECTING HIGHLIGHTED TEXT - SEE PRICING table ABOVE.</strong></p></td>
</tr>
<tr>
<td>Line 1: <input type="text" name="line_1" size="80"></td>
</tr>
<tr>
<td>Line 2: <input type="text" name="line_2" size="80"></td>
</tr>
<tr>
<td>Line 3: <input type="text" name="line_3" size="80"></td>
</tr>
<tr>
<td valign="bottom"><strong>Sample Description:</strong><img src="images/spacer.gif" width="1" height="20" border="0"></td>
</tr>
<tr>
<td>Line 1: Full service florist serving the greater</td>
</tr>
<tr>
<td>Line 2: Los Angeles area with high quality</td>
</tr>
<tr>
<td>Line 3: floral gifts and unique services.</td>
</tr>
<tr>
<td valign="bottom"><strong>Please refer to:</strong> <a href="http://myteleflora.com/internet_services/findaflorist.asp">http://myteleflora.com/internet_services/findaflorist.asp</a> for program overview.<img src="images/spacer.gif" width="1" height="20" border="0"></td>
</tr>
</table></td>
</tr>
</table></td>
</tr>
<tr>
<td>
<table class="light" bordercolor="#009900" cellspacing="0" cellpadding="0" width="100%" border="1">
<tr>
<td>
<table class="c10" cellspacing="0" cellpadding="5" width="100%" border="0">
<tr>
<td>
<table class="light" cellspacing="0" cellpadding="5" width="100%" border="0">
<tr>
<td>If you have any additional comments or suggestions, enter them here. Also, if you have any notes on your URL preferences, please feel free to use this space to tell us what you’d like:</td>
</tr>
</table>
<textarea name="Additional_Comments" id="Additional_Comments" rows="2" cols="50"></textarea></td>
</tr>
</table></td>
</tr>
</table></td>
</tr>
<tr>
<td><strong><span class="dark">findaflorist Terms of Use</span></strong><br>
<table class="light" bordercolor="#009900" cellspacing="0" cellpadding="0" width="100%" border="1">
<tr>
<td>
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<strong><span class="dark">I understand that my website will be constructed with the information and options shown on this page. Additionally, before my site is launched, I understand that I will be contacted to review and approve my website content. I also understand that my membership is subject to the <a href="#">eFlorist Program Terms of Use</a> posted here.</span></strong>
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