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<body>
<form name="Heawood_website_form" method="post" action="http://www.heawood.com/cgi-bin/formmail.pl">
<input type="hidden" name="recipient" value="webform@heawood.com">
<input type="hidden" name="redirect" value="http://www.heawood.com/thanks.htm">
<input type="hidden" name="subject" value="Form from Heawood website">
<input type="hidden" name="required" value="name, postcode, telephone, email">
<table width="600" border="0" align="center" cellpadding="0" cellspacing="0">
<tr>
<td height="40" colspan="3"> <div align="center" class="boxlist">
<p>Contact Us</p>
</div></td>
</tr>
<tr class="maintext">
<td width="179"> </td>
<td width="111"> </td>
<td width="310">* required field</td>
</tr>
<tr class="maintext">
<td><div align="right">*</div></td>
<td>Name:</td>
<td><input name="name" type="text" id="name"></td>
</tr>
<tr class="maintext">
<td> </td>
<td>Company:</td>
<td><input name="company" type="text" id="company"></td>
</tr>
<tr class="maintext">
<td> </td>
<td>Position:</td>
<td><input name="position" type="text" id="position"></td>
</tr>
<tr class="maintext">
<td> </td>
<td>Address:</td>
<td><textarea name="address" id="address"></textarea></td>
</tr>
<tr class="maintext">
<td><div align="right">*</div></td>
<td>Postcode:</td>
<td><input name="postcode" type="text" id="postcode"></td>
</tr>
<tr class="maintext">
<td> </td>
<td>Country:</td>
<td><input name="country" type="text" id="country"></td>
</tr>
<tr class="maintext">
<td><div align="right">*</div></td>
<td>Telephone:</td>
<td><input name="telephone" type="text" id="telephone"></td>
</tr>
<tr class="maintext">
<td> </td>
<td>Fax:</td>
<td><input name="fax" type="text" id="fax"></td>
</tr>
<tr class="maintext">
<td><div align="right">*</div></td>
<td>Email:</td>
<td><input name="email" type="text" id="email"></td>
</tr>
<tr class="maintext">
<td> </td>
<td>Web address:</td>
<td><input name="webaddress" type="text" id="webaddress"></td>
</tr>
<tr class="maintext">
<td colspan="2">Please tell us the nature of your enquiry: </td>
<td><input name="enquirynature" type="text" id="enquirynature"></td>
</tr>
<tr class="maintext">
<td colspan="2">We would like to talk to: </td>
<td><input name="talk" type="text" id="talk"></td>
</tr>
<tr class="maintext">
<td colspan="2">We would like to arrange an appointment:</td>
<td><input type="checkbox" name="checkbox" value="appointment required"></td>
</tr>
<tr class="maintext">
<td colspan="2">Please tell us more: </td>
<td><textarea name="more" id="more"></textarea></td>
</tr>
<tr class="maintext">
<td colspan="3"> <div align="center">
<input type="submit" name="Submit" value="Submit">
<input type="reset" name="Submit2" value="Clear">
</div></td>
</tr>
</table>
<br>
<table width="600" border="0" align="center" cellpadding="0" cellspacing="0">
<tr>
<td width="123"> </td>
<td width="477" class="maintext"><p>Heawood Research Limited, 1A Village Road,
Prenton, CH43 5SR<br>
Call Peter Knowles on 01625 582829 or Fax 01625 590073<br>
Nikki McGrail on 0151670 9700 or Fax 0151670 9703</p>
<p> </p></td>
</tr>
<tr>
<td colspan="2">
<hr>
<div align="center" class="maintext"><a href="index.htm" target="_parent">home</a> | <a href="placement-test.htm" target="_parent">placement tests</a> | <a href="design-evaluation.htm" target="_parent">qualitative and quantitative research </a> | <a href="advertising-research.htm" target="_parent">advertising research</a> | <a href="staff-satisfaction-survey.htm" target="_parent">staff surveys</a> <br>
<a href="customer-satisfaction-survey.htm" target="_parent">customer satisfaction surveys </a> | <a href="marketing-research-and-strategy.htm" target="_parent">marketing research and strategy </a>| <a href="contact.htm" target="_parent">contact us</a> | <a href="team.htm" target="_parent"> team</a> </div>
</td>
</tr>
<tr>
<td colspan="2"> </td>
</tr>
</table>
</form>
</body>
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