Untitled

<!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=iso-8859-1" />
<title>Westchester Modular Homes, Inc.</title>
<style type="text/css">
html, body, p, div, h1, h2, h3, h4, h5, h6, img, span, ul, li, br, hr, a, form, input, tr, td, table, dl, dt, dd { padding:0px; margin:0px; border:0px; list-style:none;}
body{
background:#FAF0DD url(../images/top_graphic.gif) no-repeat center top;
font-family:Georgia, "Times New Roman", Times, serif;
font-size:14px;
line-height:18px;
color:#231F20;
}
h1 {font:normal 22px/25px Georgia, "Times New Roman", Times, serif; color:#585153;}
h2 {font:normal 18px/22px Georgia, "Times New Roman", Times, serif; color:#A03755; padding-bottom:5px;}
.clr {font-size:0; height:0; line-height:0; clear:both;}
.form_box {margin:0 0 10px 5px; padding:0;}
</style></head>

<body>
<div>
<div class="index_wrap">
        <!--Left Panel Start -->
        <!--Left Panel End -->
        <!--Right Panel Start -->
<div style="margin-left:20px;">
  <h1>Builder Program Inquiry</h1>
    <p>&nbsp;</p>

  <div class="right_homesbox">

    <h2>1. Company Information</h2>
    <p>&nbsp;</p>
    <div style="background-color:#EAE1CF; padding:10px 0 10px 0; width:620px; float:left">

    <div class="form_box">
      <div class="form_box1">Contact Name: '.$_POST['contact_name'].' </div>
    </div>
        <div class="form_box">
      <div class="form_box1">Title: '.$_POST['title'].' </div>
    </div>
    <div class="form_box">
      <div class="form_box1">Business Name: '.$_POST['business_name'].' </div>
    </div>
    <div class="form_box">
      <div class="form_box1">Business Address: '.$_POST['business_addr'].' </div>
    </div>
    <div class="form_box">
      <div class="form_box1">City: '.$_POST['city'].' </div>
    </div>
    <div class="form_box">
      <div class="form_box1">State: '.$_POST['state'].' </div>
    </div>
    <div class="form_box">
      <div class="form_box1">Zip: '.$_POST['zip'].' </div>
    </div>
    <div class="form_box">
      <div class="form_box1">Business Phone: '.$_POST['phone'].' </div>
    </div>
    <div class="form_box">
      <div class="form_box1">Fax: '.$_POST['fax'].' </div>
    </div>
    <div class="form_box">
      <div class="form_box1">E-mail Address<strong>:</strong> '.$_POST['email'].' </div>
    </div>
    <div class="form_box">
      <div class="form_box1">Web Page: '.$_POST['url'].' </div>
    </div>
    <div class="clr"></div>
    </div>
    <div class="clr"></div>

    <p>&nbsp;</p>
    <h2>2. Type of Business</h2>
    <p>&nbsp;</p>
    <div style="background-color:#EAE1CF; padding:10px 0 15px 0; width:620px; float:left">
    <div class="form_box">
      <div class="form_box1">Business Type: '.$_POST['business_type'].' </div>
    </div>
    <div class="form_box">
      <div class="form_box1" align="">If other, explain:&nbsp;&nbsp;'.$_POST['other'].'&nbsp;&nbsp;&nbsp;&nbsp;</div>
    </div>
    <div class="form_box">
      <div class="form_box1">Ownership: '.$_POST['ownership'].' </div>
    </div>
    <div class="form_box">
      <div class="form_box1" align="">If other, explain: '.$_POST['other_owner'].' &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</div>
    </div>
    <div class="form_box">
      <div class="form_box1">Date Established: '.$date_estd.' </div>
      <div class="form_box3"></div>
    </div>

    <div class="form_box">
      <div class="form_box1">Full Time Employees: '.$_POST['fulltime'].' </div>
      <div class="clr"></div>
    </div>
    <div class="form_box">
    <div class="form_box1">Part Time Employees: '.$_POST['parttime'].' </div>
    <div class="clr"></div>
  </div>

  </div></div></div></div></div><div class="clr"></div>
</body></html>