ActionWare Inquiry Form - Contact and Activity Management Software

<body> <font face="Arial, Verdana"></font><table border="0" width="600"> <tr> <td><form action="http://www.appintec.com/cgi-bin/wb020" method="POST"> <p align="center"><font size="6" face="Arial, Verdana"><strong>ActionWare Inquiry Form</strong></font><font face="Arial, Verdana"> </font></p> <p align="center"><font size="4" face="Arial, Verdana">Thank you for your interest in our products!</font></p> <p align="center"><font size="4" face="Arial, Verdana">Your inquiry will be routed<br> to the appropriate person who will promptly respond.</font></p> <p align="center"><font size="3" face="Arial, Verdana">(The information you provide is kept confidential) </font></p> </form> </td> </tr> <tr> <td><hr noshade width="75%" color="#000080"> </td> </tr> <tr> <td><font color="#000080" face="Arial, Verdana">Fields marked with</font><font face="Arial, Verdana"> </font><font color="#FF0000" face="Arial, Verdana">*</font><font face="Arial, Verdana"> </font><font color="#000080" face="Arial, Verdana">are required.</font><font face="Arial, Verdana"><br> </font></td> </tr> <tr> <td><font face="Arial, Verdana"> </font><table border="0" cellspacing="1"> <tr> <td width="35%"><font color="#000080" size="3" face="Arial, Verdana"><strong>First Name:</strong></font><font color="#FF0000" size="3" face="Arial, Verdana"><strong>*</strong></font></td> <td width="65%"><font color="#000080" size="3" face="Arial, Verdana"><input type="text" size="20" maxlength="20" name="first_name"></font></td> </tr> <tr> <td width="35%"><font color="#000080" size="3" face="Arial, Verdana"><strong>Last Name:</strong></font><font color="#FF0000" size="3" face="Arial, Verdana"><strong>*</strong></font></td> <td width="65%"><font color="#000080" size="3" face="Arial, Verdana"><input type="text" size="20" maxlength="20" name="last_name"></font></td> </tr> <tr> <td width="35%"><font color="#000080" size="3" face="Arial, Verdana"><strong>Your title</strong>:</font></td> <td width="65%"><font color="#000080" size="3" face="Arial, Verdana"><input type="text" size="35" maxlength="35" name="title"></font></td> </tr> <tr> <td width="35%"><font color="#000080" size="3" face="Arial, Verdana"><strong>Company Name:</strong></font><font color="#FF0000" size="3" face="Arial, Verdana"><strong>*</strong></font></td> <td width="65%"><font color="#000080" size="3" face="Arial, Verdana"><input type="text" size="35" maxlength="35" name="comp_name"></font></td> </tr> <tr> <td width="35%"><font color="#000080" size="3" face="Arial, Verdana"><strong>Street Address:</strong></font><font color="#FF0000" size="3" face="Arial, Verdana"><strong>*</strong></font></td> <td width="65%"><font color="#000080" size="3" face="Arial, Verdana"><input type="text" size="35" maxlength="35" name="address"></font></td> </tr> <tr> <td width="35%"><font color="#000080" size="3" face="Arial, Verdana"><strong>Suite NO./PO Box:</strong> </font></td> <td width="65%"><font color="#000080" size="3" face="Arial, Verdana"><input type="text" size="35" maxlength="35" name="suite_po"></font></td> </tr> <tr> <td width="35%"><font color="#000080" size="3" face="Arial, Verdana"><strong>City:</strong></font><font color="#FF0000" size="3" face="Arial, Verdana"><strong>*</strong></font><font color="#000080" size="3" face="Arial, Verdana"> </font></td> <td width="65%"><font color="#000080" size="3" face="Arial, Verdana"><input type="text" size="30" maxlength="30" name="city"></font></td> </tr> <tr> <td width="35%"><font color="#000080" size="3" face="Arial, Verdana"><strong>State/Province:</strong></font></td> <td width="65%"><font color="#000080" size="3" face="Arial, Verdana"><strong><select name="state" size="1"> <option value=" ">Select One</option> <option value="NA">NA Not Applicable</option> <option value="AL">AL Alabama</option> <option value="AK">AK Alaska</option> <option value="AR">AR Arkansas</option> <option value="AZ">AZ Arizona</option> <option value="CA">CA California</option> <option value="CO">CO Colorado</option> <option value="CT">CT Connecticut</option> <option value="DE">DE Delaware</option> <option value="FL">FL Florida</option> <option value="GA">GA Georgia</option> <option value="HI">HI Hawaii</option> <option value="IA">IA Iowa</option> <option value="ID">ID Idaho</option> <option value="IL">IL Illinois</option> <option value="IN">IN Indiana</option> <option value="KS">KS Kansas</option> <option value="KY">KY Kentucky</option> <option value="LA">LA Louisiana</option> <option value="MA">MA Massachusetts</option> <option value="MD">MD Maryland</option> <option value="ME">ME Maine</option> <option value="MI">MI Michigan</option> <option value="MN">MN Minnesota</option> <option value="MO">MO Missouri</option> <option value="MS">MS Mississippi</option> <option value="MT">MT Montana</option> <option value="NC">NC North Carolina</option> <option value="ND">ND North Dakota</option> <option value="NE">NE Nebraska</option> <option value="NH">NH New Hampshire</option> <option value="NJ">NJ New Jersey</option> <option value="NM">NM New Mexico</option> <option value="NV">NV Nevada</option> <option value="NY">NY New York</option> <option value="OH">OH Ohio</option> <option value="OK">OK Oklahoma</option> <option value="OR">OR Oregon</option> <option value="PA">PA Pennsylvania</option> <option value="RI">RI Rhode Island</option> <option value="SC">SC South Carolina</option> <option value="SD">SD South Dakota</option> <option value="TN">TN Tennessee</option> <option value="TX">TX Texas</option> <option value="UT">UT Utah</option> <option value="VA">VA Virginia</option> <option value="VT">VT Vermont</option> <option value="WA">WA Washington</option> <option value="WI">WI Wisconsin</option> <option value="WY">WY Wyoming</option> <option value="WV">WV West Virginia</option> <option value=" ">**************************************</option> <option value=" ">** USA TERRITORIES & MISC **</option> <option value=" ">**************************************</option> <option value="DC">DC District of Columbia</option> <option value="GU">GU Guam</option> <option value="PR">PR Puerto Rico</option> <option value="VI">VI Virgin Islands</option> <option value=" ">**************************************</option> <option value=" ">***** AUSTRALIAN STATES *****</option> <option value=" ">**************************************</option> <option value="ACT">ACT Australian Capital Territory</option> <option value="NSW">NSW New South Wales</option> <option value="NT">NT Northern Territory</option> <option value="QLD">QLD Queensland</option> <option value="SA">SA South Australia</option> <option value="TAS">TAS Tasmania</option> <option value="VIC">VIC Victoria</option> <option value="WA">WA Western Australia</option> <option value=" ">**************************************</option> <option value=" ">*** CANADIAN PROVINCES ***</option> <option value=" ">**************************************</option> <option value="AB">AB Alberta</option> <option value="BC">BC British Columbia</option> <option value="MB">MB Manitoba</option> <option value="NB">NB New Brunswick</option> <option value="NF">NF Newfoundland</option> <option value="NS">NS Nova Scotia</option> <option value="ON">ON Ontario</option> <option value="SK">SK Saskatchewan</option> <option value="QB">QB Quebec</option> <option value=" ">**************************************</option> <option value=" ">******** MEXICO STATES ********</option> <option value=" ">**************************************</option> <option value="AGS">AGS Aguascalientes</option> <option value="BCA">BCA Baja California</option> <option value="BCS">BCS Baja California Sur</option> <option value="CAMP">CAMP Campeche</option> <option value="CHIH">CHIH Chihuahua</option> <option value="CHIS">CHIS Chiapas</option> <option value="COAH">COAH Coahuila</option> <option value="COL">COL Colima</option> <option value="DUR">DUR Durango</option> <option value="DF">DF Mexico City</option> <option value="GRO">GRO Guerrero</option> <option value="GUA">GUA Guanajuato</option> <option value="HGO">HGO Hidalgo</option> <option value="JAL">JAL Jalisco</option> <option value="MICH">MICH Michoacan</option> <option value="NAY">NAY Nayarit</option> <option value="NL">NL Nuevo Leon</option> <option value="OAX">OAX Oaxaca</option> <option value="PUE">PUE Puebla</option> <option value="QR">QR Quintana Roo</option> <option value="QRO">QRO Queretaro</option> <option value="SIN">SIN Sinaloa</option> <option value="SLP">SLP San Luis Potosi</option> <option value="SON">SON Sonora</option> <option value="TAB">TAB Tabasco</option> <option value="TAMP">TAMP Tamaulipas</option> <option value="TLAX">TLAX Tlaxcala</option> <option value="VER">VER Vera Cruz</option> <option value="YUC">YUC Yucatan</option> <option value="ZAC">ZAC Zacatecas</option> </select></strong></font></td> </tr> <tr> <td width="35%"><font color="#000080" size="3" face="Arial, Verdana"><strong>Zip/Postal Code:</strong></font></td> <td width="65%"><font color="#000080" size="3" face="Arial, Verdana"><strong><input type="text" size="10" maxlength="10" name="zip_postal"> </strong></font></td> </tr> <tr> <td width="35%"><font color="#000080" size="3" face="Arial, Verdana"><strong>Country:</strong></font></td> <td width="65%"><font color="#000080" size="3" face="Arial, Verdana"><strong><select name="country" size="1"> <option value=" ">Select One</option> <option value="United States">United States</option> <option value="Argentia">Argentina</option> <option value="Australia">Australia</option> <option value="Austria">Austria</option> <option value="Belgium">Belgium</option> <option value="Barzil">Brazil</option> <option value="Canada">Canada</option> <option value="Chile">Chile</option> <option value="China">China</option> <option value="Denmark">Denmark</option> <option value="Egypt">Egypt</option> <option value="El Salvador">El Salvador</option> <option value="Finland">Finland</option> <option value="France">France</option> <option value="Germany">Germany</option> <option value="Hong Kong">Hong Kong</option> <option value="India">India</option> <option value="Ireland">Ireland</option> <option value="Israel">Israel</option> <option value="Italy">Italy</option> <option value="Japan">Japan</option> <option value="Korea">Korea</option> <option value="Mexico">Mexico</option> <option value="Netherlands">Netherlands</option> <option value="New Zealand">New Zealand</option> <option value="Norway">Norway</option> <option value="Pakistan">Pakistan</option> <option value="Peru">Peru</option> <option value="Phillippines">Phillippines</option> <option value="Poland">Poland</option> <option value="Portugal">Portugal</option> <option value="Singapore">Singapore</option> <option value="South Africa">South Africa</option> <option value="Spain">Spain</option> <option value="Sweden">Sweden</option> <option value="Switzerland">Switzerland</option> <option value="Taiwan">Taiwan</option> <option value="United Kingdom">United Kingdom</option> <option value="Venezuela">Venezuela</option> <option value="Other">Other</option> </select></strong></font></td> </tr> <tr> <td width="65"><font color="#000080" size="3" face="Arial, Verdana"><strong>Business Phone:</strong></font><font color="#FF0000" size="3" face="Arial, Verdana"><strong>*</strong></font></td> <td width="0"><font color="#000080" size="3" face="Arial, Verdana"><strong><input type="text" size="26" maxlength="26" name="bus_phone"> </strong></font></td> </tr> <tr> <td><font color="#000080" size="3" face="Arial, Verdana"><strong>Fax Number:</strong></font></td> <td><font color="#000080" size="3" face="Arial, Verdana"><strong><input type="text" size="26" maxlength="26" name="fax_num"></strong></font></td> </tr> <tr> <td><font color="#000080" size="3" face="Arial, Verdana"><strong>Email Address:</strong></font></td> <td><font color="#000080" size="3" face="Arial, Verdana"><strong><input type="text" size="64" maxlength="64" name="email"></strong></font></td> </tr> <tr> <td><font color="#000080" size="3" face="Arial, Verdana"><strong>URL:</strong></font></td> <td><font color="#000080" size="3" face="Arial, Verdana"><strong><input type="text" size="64" maxlength="64" name="url"></strong></font></td> </tr> </table> <p><font face="Arial, Verdana"> </font></p> </td> </tr> <tr> <td><hr noshade width="75%" color="#000080"> </td> </tr> <font face="Arial, Verdana"></font> <tr> <td><table border="0" cellspacing="1"> <tr> <td><font color="#000080" size="3" face="Arial, Verdana"><strong>Your industry type?</strong></font></td> <td><font color="#000080" size="3" face="Arial, Verdana"><strong><select name="indus_type" size="1"> <option value=" ">Select One</option> <option value="Avia">Aviation</option> <option value="Char">Charities/Non-Profit Org.</option> <option value="Cons">Construction Company</option> <option value="Cslt">Consultant</option> <option value="Dist">Distribution</option> <option value="Educ">Education/Technical College</option> <option value="Ener">Energy/Gas/Oil/Coal</option> <option value="Ente">Entertainment Field</option> <option value="Fina">Financial Institution/Banking/Securities</option> <option value="Gove">Goverment</option> <option value="Heal">Health Service Related Companies</option> <option value="High">High-Tech Products (Computers/Software)</option> <option value="Huma">Human Resources/Personnel/Staffing Companies</option> <option value="Insu">Insurance Industry-Related Companies</option> <option value="Leas">Leasing Companies</option> <option value="Medi">Medical Supply/Medical Related Companies</option> <option value="Manu">Manufacturing</option> <option value="Mark">Marketing Svcs/Advertising/Public Relations</option> <option value="Prof">Professional Practices</option> <option value="Publ">Publishing</option> <option value="Real">Real Estate</option> <option value="Reta">Retail</option> <option value="Serv">Service</option> <option value="Sale">Sales Organizations</option> <option value="Tele">Telecommunications</option> <option value="Tran">Transportation</option> <option value="Trav">Travel/Tourism</option> <option value="Publ">Public Utilities</option> <option value="Othe">Other</option> </select> </strong></font></td> </tr> </table> <p><font face="Arial, Verdana"> <br> </font><font color="#000080" size="3" face="Arial, Verdana"><strong>What ActionWare products/application are you interested in? (Select all that apply)</strong></font><font face="Arial, Verdana"> </font></p> <div align="left"><table border="0" cellspacing="1"> <tr> <td><font color="#000080" size="3" face="Arial, Verdana"><input type="checkbox" name="producta" value="Yes">Sales</font></td> <td><font color="#000080" size="3" face="Arial, Verdana"><input type="checkbox" name="productb" value="Yes">Marketing </font></td> <td><font color="#000080" size="3" face="Arial, Verdana"><input type="checkbox" name="productc" value="Yes">Call Center</font></td> </tr> <tr> <td><font color="#000080" size="3" face="Arial, Verdana"><input type="checkbox" name="productd" value="Yes">Customer Service</font></td> <td><font color="#000080" size="3" face="Arial, Verdana"><input type="checkbox" name="producte" value="Yes">Enterprise-Wide</font></td> </tr> </table> </div><p><font face="Arial, Verdana"><br> </font><font color="#000080" size="3" face="Arial, Verdana"><strong>Is your company currently using an ActionWare product? </strong><br> <input type="radio" name="curr_prod" value="Yes"> Yes <input type="radio" name="curr_prod" value="No"> No</font><font face="Arial, Verdana"> </font></p> <p><font color="#000080" size="3" face="Arial, Verdana"><strong>If yes, please specify the applications:</strong></font><font face="Arial, Verdana"><br> </font></p> <table border="0" cellpadding="3" cellspacing="1"> <tr> <td><font color="#000080" size="3" face="Arial, Verdana"><input type="checkbox" name="appsa" value="Yes">actionware.com</font></td> <td><font color="#000080" size="3" face="Arial, Verdana"><input type="checkbox" name="appsb" value="Yes">ActionWareGUI</font></td> <td><font color="#000080" size="3" face="Arial, Verdana"><input type="checkbox" name="appsc" value="Yes">ActionWare400</font></td> </tr> </table> <p align="left"><font color="#000080" size="3" face="Arial, Verdana"><strong>If yes, what training and support services are you currently interested in?</strong></font><font face="Arial, Verdana"><br> </font></p> <div align="left"><table border="0" cellpadding="3" cellspacing="1"> <tr> <td><font color="#000080" size="3" face="Arial, Verdana"><input type="checkbox" name="traininga" value="Yes">User Training</font></td> <td><font color="#000080" size="3" face="Arial, Verdana"><input type="checkbox" name="trainingb" value="Yes">System Administration</font></td> </tr> <tr> <td><font color="#000080" size="3" face="Arial, Verdana"><input type="checkbox" name="trainingc" value="Yes">Database Design</font></td> <td><font color="#000080" size="3" face="Arial, Verdana"><input type="checkbox" name="trainingd" value="Yes">Data Load Utility</font></td> </tr> <tr> <td><font color="#000080" size="3" face="Arial, Verdana"><input type="checkbox" name="traininge" value="Yes">Upgrade/Migration Support </font></td> <td><font color="#000080" size="3" face="Arial, Verdana"><input type="checkbox" name="trainingf" value="Yes">Knowledge System Planning (KSP)</font></td> </tr> <tr> <td><font color="#000080" size="3" face="Arial, Verdana"><input type="checkbox" name="trainingg" value="Yes">Other-please contact</font></td> </tr> </table> </div><p><font color="#000080" size="3" face="Arial, Verdana"><strong><input type="checkbox" name="enroll_me" value="Yes"> I want to receive your newsletter...please enroll me! </strong></font></p> <p><font color="#000080" size="3" face="Arial, Verdana"><strong>Do you own an IBM AS/400?</strong><br> <input type="radio" name="own_ibm" value="Yes">Yes <input type="radio" name="own_ibm" value="No"> No</font></p> <p align="left"><font color="#000080" size="3" face="Arial, Verdana"><strong>Please tell us how you learned about ActionWare:</strong></font><font face="Arial, Verdana"><br> </font></p> <div align="left"><table border="0" cellspacing="1"> <tr> <td><font color="#000080" size="3" face="Arial, Verdana"><input type="checkbox" name="learna" value="Yes">Web Search</font></td> <td><font color="#000080" size="3" face="Arial, Verdana"><input type="checkbox" name="learnb" value="Yes">Marketing Literature</font></td> <td><font color="#000080" size="3" face="Arial, Verdana"><input type="checkbox" name="learnc" value="Yes">User Reference</font></td> </tr> <tr> <td><font color="#000080" size="3" face="Arial, Verdana"><input type="checkbox" name="learnd" value="Yes">Publications</font></td> <td><font color="#000080" size="3" face="Arial, Verdana"><input type="checkbox" name="learne" value="Yes">Other </font></td> </tr> </table> </div><p><font color="#000080" size="3" face="Arial, Verdana"><strong>Comments:</strong></font><font face="Arial, Verdana"><strong> </strong><br> </font><font color="#000080" size="3" face="Arial, Verdana"><textarea name="comments" rows="9" cols="60" wrap="physical"></textarea> </font></p> <p><font face="Arial, Verdana"><input type="submit" name="B1" value="Submit"> <input type="reset" name="B2" value="Start Over"> </font></p> </td> </tr> </table> <form> <p><input type="button" value="Return to Previous" onclick="history.back()"> </p> </form> <blockquote> <p align="center"><a href="../../" target="_top">Home Page</a></p> </blockquote> </body>