Your IP : 216.73.217.79
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=UTF-8" />
<title>CESA Member Booking Form</title>
<style type="text/css">
body,td,th {
font-family: Verdana, Geneva, sans-serif;
font-size: 10px;
color: #000;
}
body {
background-color: #FFF;
}
a:link {
color: #39F;
text-decoration: none;
}
a:visited {
text-decoration: none;
color: #333;
}
a:hover {
text-decoration: none;
color: #69F;
}
a:active {
text-decoration: none;
color: #000;
}
h1 {
font-size: 14px;
color: #06F;
}
h2 {
font-size: 11px;
color: #333;
line-height: 4px;
margin-bottom: 5px;
margin-top: 15px;
}
#fullform{
background:url(images/new-bg.png);
background-position:top;
background-repeat:no-repeat;
/*min-height:1476px;*/
min-height:900px;
}
</style>
<script src="SpryAssets/SpryValidationTextField.js" type="text/javascript"></script>
<script src="SpryAssets/SpryValidationSelect.js" type="text/javascript"></script>
<script src="SpryAssets/SpryValidationTextarea.js" type="text/javascript"></script>
<link href="SpryAssets/SpryValidationTextField.css" rel="stylesheet" type="text/css" />
<link href="SpryAssets/SpryValidationSelect.css" rel="stylesheet" type="text/css" />
<link href="SpryAssets/SpryValidationTextarea.css" rel="stylesheet" type="text/css" />
</head>
<body topmargin="0">
<form action="process.php" method="post">
<input type="hidden" name="form_tools_form_id" value="1" />
<table width="600" border="0" align="center" cellpadding="0" cellspacing="0">
<tr>
<td colspan="3"><img src="images/Header_form.png" width="650" height="317" alt="CESA" /></td>
</tr>
<tr>
<td width="24"> </td>
<td width="602"><h1>ADVERTISING BOOKING FORM:</h1></td>
<td width="24"> </td>
</tr>
<tr>
<td valign="top"> </td>
<td valign="top"><table width="600" border="0" align="left" cellpadding="5" cellspacing="0">
<!-- <p>
** Required Fields
</p> -->
<tr>
<td width="141" align="right">Company Name:</td>
<td width="414">
<span id="sprytextfield1">
<label for="Name of Firm"></label>
<input name="Name of Firm" type="text" id="Name of Firm" size="55" />
<span class="textfieldRequiredMsg">This is required.</span></span>
</td>
<td width="15"> </td>
</tr>
<tr>
<td align="right">Contact Person:</td>
<td> <span id="sprytextfield2">
<label for="Contact Person"></label>
<input name="Contact Person" type="text" id="Contact Person" size="55" />
<span class="textfieldRequiredMsg">This is required.</span>
</span></td>
<td> </td>
</tr>
<tr>
<td align="right">Email Address:</td>
<td><span id="sprytextfield3">
<label for="Email Address"></label>
<input name="Email Address" type="text" id="Email Address" size="55" />
<span class="textfieldInvalidFormatMsg">Invalid format.</span>
<span class="textfieldRequiredMsg">This is required.</span>
</span></td>
<td> </td>
</tr>
<tr>
<td align="right">Designation:</td>
<td> <span id="sprytextfield4">
<label for="Designation"></label>
<input name="Designation" type="text" id="Designation" size="55" />
<span class="textfieldRequiredMsg">This is required.</span>
</span></td>
<td> </td>
</tr>
<tr>
<td align="right">Order No:</td>
<td> <span id="sprytextfield5">
<label for="Order No"></label>
<input name="Order No" type="text" id="Order No" size="55" />
<span class="textfieldRequiredMsg">This is required.</span>
</span></td>
<td> </td>
</tr>
<tr>
<td align="right">VAT Registration No:</td>
<td> <span id="sprytextfield6">
<label for="VAT Registration No"></label>
<input name="VAT Registration No" type="text" id="VAT Registration No" size="55" />
<span class="textfieldRequiredMsg">This is required.</span>
</span></td>
<td> </td>
</tr>
<tr>
<td align="right">Physical Address:</td>
<td><span id="sprytextarea1">
<label for="Physical Address"></label>
<textarea name="Physical Address" id="Physical Address" cols="40" rows="5"></textarea>
</span></td>
<td> </td>
</tr>
<tr>
<td align="right">Postal Address:</td>
<td><span id="sprytextarea2">
<label for="Postal Address"></label>
<textarea name="Postal Address" id="Postal Address" cols="40" rows="5"></textarea>
</span></td>
<td> </td>
</tr>
<tr>
<td align="right">Telephone Number:</td>
<td><span id="sprytextfield7">
<label for="Telephone Number"></label>
<input name="Telephone Number" type="text" id="Telephone Number" size="55" />
<span class="textfieldRequiredMsg">This is required.</span>
</span></td>
<td> </td>
</tr>
<tr>
<td align="right">Fax Number:</td>
<td><span id="sprytextfield8">
<label for="Fax Number"></label>
<input name="Fax Number" type="text" id="Fax Number" size="55" />
</span></td>
<td> </td>
</tr>
<tr>
<td align="right">Cell Number:</td>
<td><span id="sprytextfield9">
<label for="Cell Number"></label>
<input name="Cell Number" type="text" id="Cell Number" size="55" />
<!--<span class="textfieldRequiredMsg">This is required.</span>-->
</span></td>
<td> </td>
</tr>
<tr>
<td align="right" valign="top">Type of Advert:</td>
<td valign="top"><span id="spryselect1">
<label for="Advert Type"></label>
<select name="Advert Type" size="1" id="Advert Type">
<option selected="selected">Please Select an Advert Type</option>
<option value="Quarter Page - R8 925.00">Quarter Page - R8 925.00</option>
<option value="Half Page - R11 025.00">Half Page - R11 025.00</option>
<option value="Full Page - R15 225.00">Full Page - R15 225.00</option>
<option value="Page 1 (Full page) - R19 950.00">Page 1 (Full page) - R19 950.00</option>
<option value="Page 2 (Full page) - R19 950.00">Page 2 (Full page) - R19 950.00</option>
<option value="Inside Cover (Front and Back) - R27 300.00">Inside Cover (Front and Back) - R27 300.00</option>
<option value="Back Cover (Outside) - R31 500.00">Back Cover (Outside) - R31 500.00</option>
</select>
<span class="textfieldRequiredMsg">This is required.</span>
</span>
</td>
<td> </td>
</tr>
<tr>
<td align="right"> </td>
<td colspan="2"><label for="Submit"></label>
<input type="submit" name="Submit" id="Submit" value="Submit" /></td>
</tr>
</table>
</td>
<td> </td>
</tr>
<tr>
<td valign="top"> </td>
<td valign="top"><p><br />
All prices are exclusive of agency commission and VAT. A detailed invoice will be issued (VAT Reg no. 4170109013)
upon receipt of this booking form.<br /><br />
Payments to CESA trading as SAACE by cheque or direct transfer to:
<br />
<strong>Bank:</strong> Nedbank <br />
<strong>Branch:</strong>Ferndale <br />
<strong>Account No.</strong>: 1922 019 801<br />
<strong>Branch Code</strong>: 1922 05<br />
<strong>Reference:</strong> DIREC2017_your company name</p>
<p> </p></td>
<td> </td>
</tr>
<tr valign="top">
<!-- <td colspan="3"><p><img src="http://www.cesa.co.za/Directory2014/images/Footer_Form.png" width="650" height="229" alt="Footer" /></p>-->
<td colspan="3"><p><img src="images/Footer_Form.png" width="650" height="236" alt="Footer" /></p>
<p> </p></td>
</tr>
</table></form>
<script type="text/javascript">
<!--
var sprytextfield1 = new Spry.Widget.ValidationTextField("sprytextfield1");
var sprytextfield2 = new Spry.Widget.ValidationTextField("sprytextfield2");
var sprytextfield3 = new Spry.Widget.ValidationTextField("sprytextfield3", "email");
var sprytextfield4 = new Spry.Widget.ValidationTextField("sprytextfield4", "none", {isRequired:false});
var sprytextfield5 = new Spry.Widget.ValidationTextField("sprytextfield5", "none", {isRequired:false});
var sprytextfield6 = new Spry.Widget.ValidationTextField("sprytextfield6", "none", {isRequired:false});
var sprytextfield7 = new Spry.Widget.ValidationTextField("sprytextfield7");
var sprytextfield8 = new Spry.Widget.ValidationTextField("sprytextfield8", "none", {isRequired:false});
var sprytextfield9 = new Spry.Widget.ValidationTextField("sprytextfield9", "none", {isRequired:false});
var spryselect1 = new Spry.Widget.ValidationSelect("spryselect1");
var sprytextarea1 = new Spry.Widget.ValidationTextarea("sprytextarea1", {isRequired:false});
var sprytextarea2 = new Spry.Widget.ValidationTextarea("sprytextarea2", {isRequired:false});
//-->
</script>
</body>
</html>