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	<lastBuildDate>Tue, 07 Sep 2010 21:15:35 +0000</lastBuildDate>
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		<title>WISSOTA 100 Event Merchandise</title>
		<link>http://feedproxy.google.com/~r/PerfPromo/~3/TQLnwflKI7A/wissota-100-event-merchandise-2</link>
		<comments>http://perfpromotions.com/wp/latest-work/race-teams/special-prints/wissota-100-event-merchandise-2#comments</comments>
		<pubDate>Tue, 07 Sep 2010 21:14:48 +0000</pubDate>
		<dc:creator>PerfPromo</dc:creator>
				<category><![CDATA[Special Prints]]></category>

		<guid isPermaLink="false">http://perfpromotions.com/wp/?p=893</guid>
		<description><![CDATA[In partnership with CRP Photography, we will be offering official WISSOTA 100 Event Merchandise all week during the 2010 WISSOTA 100 in Huron, South Dakota. We will be offering event photos, mugs and key chains that can be ordered at the track, and in some cases delivered in the same day. If you would like [...]]]></description>
			<content:encoded><![CDATA[<p><iframe src="http://www.facebook.com/plugins/like.php?href=http%3A%2F%2Fperfpromotions.com%2Fwp%2Fnews%2Fwissota-100-event-merchandise&amp;layout=standard&amp;show_faces=true&amp;width=450&amp;action=recommend&amp;colorscheme=light&amp;height=80" scrolling="no" frameborder="0" style="border:none; overflow:hidden; width:450px; height:80px;" allowTransparency="true"></iframe><br />
<img alt="" src="http://perfpromotions.com/wp/wp-admin/images/wissota100_EventPhotosample_post.jpg" title="WISSOTA 100" class="alignnone" width="550" height="" /><br />
In partnership with CRP Photography, we will be offering official WISSOTA 100 Event Merchandise all week during the 2010 WISSOTA 100 in Huron, South Dakota. We will be offering event photos, mugs and key chains that can be ordered at the track, and in some cases delivered in the same day. If you would like to pre-order, simply complete our order form below.<br />
<br />
<strong>Event Photo Pricing</strong><br />
8&#215;10&#8243; Event Photo &#8211; (1) $15.00ea | (2+) $10.00ea<br />
11&#215;14&#8243; Event Photo &#8211; (1) $20.00ea | (2+) $15.00ea<br />
<br />
<strong>Event Mug Pricing</strong><br />
11 oz Black Mug &#8211; (1) $10.00ea | (2+) $10.00ea<br />
<br />
<strong>Event Key Chain Pricing</strong><br />
2&#215;3&#8243; Clear Key Chain &#8211; (1) $4.00ea | (2+) $4.00ea<br />
<br />
<strong>Payment Options</strong><br />
Orders may be payed by credit card, check by mail or at the track. If you order online you will be sent our billing information once we receive your order. All orders must be prepaid.<br />
<br />
<strong>How To Place An Order</strong><br />
We will be taking orders and printing at each event, but if you would like to pre-order now simply complete our form below. </p>
<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/caee5p3HC2xJ">
<table style="text-align:left;margin:50px 0px; padding:0px;text-align:center;width:500px;margin:0px auto;text-align:left;padding:15px;background-color:#ffffff;" cellpadding="2" cellspacing="0" border="0" bgcolor="#ffffff">
<tr>
<td style="" colspan="2"><font face="Verdana" size="2" color="#000000"><b style="font-size:20px;">WISSOTA 100</b><br /><label style="font-size:15px;">Event Product Order Form<br /></label><br /></font></td>
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<tr valign="top">
<td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Name</b></font><span style="color:red;"><small>*</small></span></td>
</tr>
<tr>
<td style="">
<input id="element_0" name="element_0" value="" size="30" class="validate[required]" type="text" />
<div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div>
</td>
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<tr valign="top">
<td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Shipping Address</b></font><span style="color:red;"><small>*</small></span></td>
</tr>
<tr>
<td style="">
<input id="element_1" name="element_1" value="" size="30" class="validate[required]" type="text" />
<div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">+$5.00 for all shipped PHOTO ONLY orders.</font></small></div>
</td>
</tr>
<tr valign="top">
<td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Address Line 2</b></font><span style="color:red;"><small></small></span></td>
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<tr>
<td style="">
<input id="element_2" name="element_2" value="" size="30" class="validate[optional]" type="text" />
<div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div>
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<tr valign="top">
<td style="" align=""><font face="Verdana" size="2" color="#000000"><b>City</b></font><span style="color:red;"><small>*</small></span></td>
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<input id="element_3" name="element_3" value="" size="30" class="validate[required]" type="text" />
<div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div>
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<tr valign="top">
<td style="" align=""><font face="Verdana" size="2" color="#000000"><b>State</b></font><span style="color:red;"><small>*</small></span></td>
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<tr>
<td style="">
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<td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Zip Code</b></font><span style="color:red;"><small>*</small></span></td>
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<tr>
<td style="">
<input id="element_5" name="element_5" class="validate[required,custom[onlyNumber]]" value="" size="10" type="text" />
<div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div>
</td>
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<tr valign="top">
<td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Phone</b></font><span style="color:red;"><small>*</small></span></td>
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<tr>
<td style="">
<input id="element_6" name="element_6" class="validate[required,custom[onlyNumber]]" value="" size="15" type="text" />
<div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div>
</td>
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<tr valign="top">
<td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Email</b></font><span style="color:red;"><small>*</small></span></td>
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<tr>
<td style="">
<input id="element_7" name="element_7" class="validate[required,custom[email]]" value="" size="30" type="text" />
<div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div>
</td>
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<tr valign="top">
<td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Drivers Name &#8211; This driver will be used for your<br />order!</b></font><span style="color:red;"><small>*</small></span></td>
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<tr>
<td style="">
<input id="element_8" name="element_8" value="" size="30" class="validate[required]" type="text" />
<div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div>
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<tr valign="top">
<td style="" align=""><font face="Verdana" size="2" color="#000000"><b>11&#215;14 Event Prints</b></font><span style="color:red;"><small>*</small></span></td>
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<tr>
<td style="">
<select id="element_9" name="element_9" class="validate[required]">
<option value=""selected="selected">&#8211;</option>
<option value="0 - None">0 &#8211; None</option>
<option value="1 - $20.00">1 &#8211; $20.00</option>
<option value="2 - $35.00">2 &#8211; $35.00</option>
<option value="3 - $50.00">3 &#8211; $50.00</option>
<option value="4 - $65.00">4 &#8211; $65.00</option>
<option value="5 - $80.00">5 &#8211; $80.00</option>
<option value="6 - $95.00">6 &#8211; $95.00</option>
<option value="7 - $110.00">7 &#8211; $110.00</option>
<option value="8 - $125.00">8 &#8211; $125.00</option>
<option value="9 - $140.00">9 &#8211; $140.00</option>
<option value="10 - $155.00">10 &#8211; $155.00</option>
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<div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div>
</td>
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<tr valign="top">
<td style="" align=""><font face="Verdana" size="2" color="#000000"><b>8&#215;10 Event Prints</b></font><span style="color:red;"><small>*</small></span></td>
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<td style="">
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<option value=""selected="selected">&#8211;</option>
<option value="0 - None">0 &#8211; None</option>
<option value="1 - $15.00">1 &#8211; $15.00</option>
<option value="2 - $25.00">2 &#8211; $25.00</option>
<option value="3 - $35.00">3 &#8211; $35.00</option>
<option value="4 - $45.00">4 &#8211; $45.00</option>
<option value="5 - $55.00">5 &#8211; $55.00</option>
<option value="6 - $65.00">6 &#8211; $65.00</option>
<option value="7 - $75.00">7 &#8211; $75.00</option>
<option value="8 - $85.00">8 &#8211; $85.00</option>
<option value="9 - $95.00">9 &#8211; $95.00</option>
<option value="10 - $105.00">10 &#8211; $105.00</option>
</select>
<div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div>
</td>
</tr>
<tr valign="top">
<td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Event Mugs</b></font><span style="color:red;"><small>*</small></span></td>
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<tr>
<td style="">
<select id="element_11" name="element_11" class="validate[required]">
<option value=""selected="selected">&#8211;</option>
<option value="0 - None">0 &#8211; None</option>
<option value="1 - $10.00">1 &#8211; $10.00</option>
<option value="2 - $20.00">2 &#8211; $20.00</option>
<option value="3 - $30.00">3 &#8211; $30.00</option>
<option value="4 - $40.00">4 &#8211; $40.00</option>
<option value="5 - $50.00">5 &#8211; $50.00</option>
<option value="6 - $60.00">6 &#8211; $60.00</option>
<option value="7 - $70.00">7 &#8211; $70.00</option>
<option value="8 - $80.00">8 &#8211; $80.00</option>
<option value="9 - $90.00">9 &#8211; $90.00</option>
<option value="10 - $100.00">10 &#8211; $100.00</option>
</select>
<div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div>
</td>
</tr>
<tr valign="top">
<td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Event Key Chains</b></font><span style="color:red;"><small>*</small></span></td>
</tr>
<tr>
<td style="">
<select id="element_12" name="element_12" class="validate[required]">
<option value=""selected="selected">&#8211;</option>
<option value="0 - None">0 &#8211; None</option>
<option value="1 - $5.00">1 &#8211; $5.00</option>
<option value="2 - $10.00">2 &#8211; $10.00</option>
<option value="3 - $15.00">3 &#8211; $15.00</option>
<option value="4 - $20.00">4 &#8211; $20.00</option>
<option value="5 - $25.00">5 &#8211; $25.00</option>
<option value="6 - $30.00">6 &#8211; $30.00</option>
<option value="7 - $35.00">7 &#8211; $35.00</option>
<option value="8 - $40.00">8 &#8211; $40.00</option>
<option value="9 - $45.00">9 &#8211; $45.00</option>
<option value="10 - $50.00">10 &#8211; $50.00</option>
</select>
<div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div>
</td>
</tr>
<tr valign="top">
<td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Customer Notes</b></font><span style="color:red;"><small></small></span></td>
</tr>
<tr>
<td style=""><textarea id="element_13" name="element_13" cols="30" rows="10" class="validate[optional] "></textarea>
<div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Once your order form is submitted, you will be<br />sent a proof and contacted with our payment<br />options. </font></small></div>
</td>
</tr>
<tr>
<td colspan="2">
<table cellpadding="5" cellspacing="0" bgcolor="#ffffff" width="100%">
<tr bgcolor="#ffffff">
<td colspan="2"><font color="#ffffff" face="Verdana" size="2"><b>Image Verification</b></font></td>
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<tr>
<td style="padding:2px; width:100px;"><img id="captcha_image" src="http://www.emailmeform.com/builder/captcha/index/22a14ae93a10282fbc728584e3dba37a" alt="captcha"></td>
<td valign="top">
<div><font color="#ffffff">Please enter the text from the image</font>:<br />
<input type="text" id="captcha_code" name="captcha_code" maxlength="10" size="10" class="validate[required,funcCall[valid_captcha]]"  />[<a id="captcha_code_refresh" href="javascript:void(0);" onclick="document.getElementById('captcha_image').src = 'http://www.emailmeform.com/builder/captcha/index/'+Math.random();get_valid_captcha();return false;">Refresh Image</a>][<a id="captcha_code_about" href="javascript:void(0);" onclick="window.open('http://www.emailmeform.com/captcha-instruction.html','_blank','width=400, height=500, left=' + (screen.width-450) + ', top=100');return false;">What's This?</a>]</div>
</td>
</tr>
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</td>
</tr>
<tr>
<td colspan="2" align="center">
<input name="element_counts" value="14" type="hidden" />
<input  value="Send email" type="submit" /></td>
</tr>
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<img src="http://feeds.feedburner.com/~r/PerfPromo/~4/TQLnwflKI7A" height="1" width="1"/>]]></content:encoded>
			<wfw:commentRss>http://perfpromotions.com/wp/latest-work/race-teams/special-prints/wissota-100-event-merchandise-2/feed</wfw:commentRss>
		<slash:comments>0</slash:comments>
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		<item>
		<title>WISSOTA 100 Event Merchandise</title>
		<link>http://feedproxy.google.com/~r/PerfPromo/~3/ipaDbCQpVOI/wissota-100-event-merchandise</link>
		<comments>http://perfpromotions.com/wp/news/wissota-100-event-merchandise#comments</comments>
		<pubDate>Tue, 07 Sep 2010 16:30:54 +0000</pubDate>
		<dc:creator>PerfPromo</dc:creator>
				<category><![CDATA[News]]></category>

		<guid isPermaLink="false">http://perfpromotions.com/wp/?p=881</guid>
		<description><![CDATA[In partnership with CRP Photography, we will be offering official WISSOTA 100 Event Merchandise all week during the 2010 WISSOTA 100 in Huron, South Dakota. We will be offering event photos, mugs and key chains that can be ordered at the track, and in some cases delivered in the same day. If you would like [...]]]></description>
			<content:encoded><![CDATA[<p><iframe src="http://www.facebook.com/plugins/like.php?href=http%3A%2F%2Fperfpromotions.com%2Fwp%2Fnews%2Fwissota-100-event-merchandise&amp;layout=standard&amp;show_faces=true&amp;width=450&amp;action=recommend&amp;colorscheme=light&amp;height=80" scrolling="no" frameborder="0" style="border:none; overflow:hidden; width:450px; height:80px;" allowTransparency="true"></iframe><br />
<img alt="" src="http://perfpromotions.com/wp/wp-admin/images/wissota100_EventPhotosample_post.jpg" title="WISSOTA 100" class="alignnone" width="550" height="" /><br />
In partnership with CRP Photography, we will be offering official WISSOTA 100 Event Merchandise all week during the 2010 WISSOTA 100 in Huron, South Dakota. We will be offering event photos, mugs and key chains that can be ordered at the track, and in some cases delivered in the same day. If you would like to pre-order, simply complete our order form below.<br />
<br />
<strong>Event Photo Pricing</strong><br />
8&#215;10&#8243; Event Photo &#8211; (1) $15.00ea | (2+) $10.00ea<br />
11&#215;14&#8243; Event Photo &#8211; (1) $20.00ea | (2+) $15.00ea<br />
<br />
<strong>Event Mug Pricing</strong><br />
11 oz Black Mug &#8211; (1) $10.00ea | (2+) $10.00ea<br />
<br />
<strong>Event Key Chain Pricing</strong><br />
2&#215;3&#8243; Clear Key Chain &#8211; (1) $4.00ea | (2+) $4.00ea<br />
<br />
<strong>Payment Options</strong><br />
Orders may be payed by credit card, check by mail or at the track. If you order online you will be sent our billing information once we receive your order. All orders must be prepaid.<br />
<br />
<strong>How To Place An Order</strong><br />
We will be taking orders and printing at each event, but if you would like to pre-order now simply complete our form below. </p>
<form id="emf-form" enctype="multipart/form-data" method="post" action="http://www.emailmeform.com/builder/form/caee5p3HC2xJ">
<table style="text-align:left;margin:50px 0px; padding:0px;text-align:center;width:500px;margin:0px auto;text-align:left;padding:15px;background-color:#ffffff;" cellpadding="2" cellspacing="0" border="0" bgcolor="#ffffff">
<tr>
<td style="" colspan="2"><font face="Verdana" size="2" color="#000000"><b style="font-size:20px;">WISSOTA 100</b><br /><label style="font-size:15px;">Event Product Order Form<br /></label><br /></font></td>
</tr>
<tr valign="top">
<td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Name</b></font><span style="color:red;"><small>*</small></span></td>
</tr>
<tr>
<td style="">
<input id="element_0" name="element_0" value="" size="30" class="validate[required]" type="text" />
<div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div>
</td>
</tr>
<tr valign="top">
<td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Shipping Address</b></font><span style="color:red;"><small>*</small></span></td>
</tr>
<tr>
<td style="">
<input id="element_1" name="element_1" value="" size="30" class="validate[required]" type="text" />
<div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">+$5.00 for all shipped PHOTO ONLY orders.</font></small></div>
</td>
</tr>
<tr valign="top">
<td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Address Line 2</b></font><span style="color:red;"><small></small></span></td>
</tr>
<tr>
<td style="">
<input id="element_2" name="element_2" value="" size="30" class="validate[optional]" type="text" />
<div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div>
</td>
</tr>
<tr valign="top">
<td style="" align=""><font face="Verdana" size="2" color="#000000"><b>City</b></font><span style="color:red;"><small>*</small></span></td>
</tr>
<tr>
<td style="">
<input id="element_3" name="element_3" value="" size="30" class="validate[required]" type="text" />
<div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div>
</td>
</tr>
<tr valign="top">
<td style="" align=""><font face="Verdana" size="2" color="#000000"><b>State</b></font><span style="color:red;"><small>*</small></span></td>
</tr>
<tr>
<td style="">
<input id="element_4" name="element_4" value="" size="3" class="validate[required]" type="text" />
<div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div>
</td>
</tr>
<tr valign="top">
<td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Zip Code</b></font><span style="color:red;"><small>*</small></span></td>
</tr>
<tr>
<td style="">
<input id="element_5" name="element_5" class="validate[required,custom[onlyNumber]]" value="" size="10" type="text" />
<div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div>
</td>
</tr>
<tr valign="top">
<td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Phone</b></font><span style="color:red;"><small>*</small></span></td>
</tr>
<tr>
<td style="">
<input id="element_6" name="element_6" class="validate[required,custom[onlyNumber]]" value="" size="15" type="text" />
<div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div>
</td>
</tr>
<tr valign="top">
<td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Email</b></font><span style="color:red;"><small>*</small></span></td>
</tr>
<tr>
<td style="">
<input id="element_7" name="element_7" class="validate[required,custom[email]]" value="" size="30" type="text" />
<div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div>
</td>
</tr>
<tr valign="top">
<td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Drivers Name &#8211; This driver will be used for your<br />order!</b></font><span style="color:red;"><small>*</small></span></td>
</tr>
<tr>
<td style="">
<input id="element_8" name="element_8" value="" size="30" class="validate[required]" type="text" />
<div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div>
</td>
</tr>
<tr valign="top">
<td style="" align=""><font face="Verdana" size="2" color="#000000"><b>11&#215;14 Event Prints</b></font><span style="color:red;"><small>*</small></span></td>
</tr>
<tr>
<td style="">
<select id="element_9" name="element_9" class="validate[required]">
<option value=""selected="selected">&#8211;</option>
<option value="0 - None">0 &#8211; None</option>
<option value="1 - $20.00">1 &#8211; $20.00</option>
<option value="2 - $35.00">2 &#8211; $35.00</option>
<option value="3 - $50.00">3 &#8211; $50.00</option>
<option value="4 - $65.00">4 &#8211; $65.00</option>
<option value="5 - $80.00">5 &#8211; $80.00</option>
<option value="6 - $95.00">6 &#8211; $95.00</option>
<option value="7 - $110.00">7 &#8211; $110.00</option>
<option value="8 - $125.00">8 &#8211; $125.00</option>
<option value="9 - $140.00">9 &#8211; $140.00</option>
<option value="10 - $155.00">10 &#8211; $155.00</option>
</select>
<div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div>
</td>
</tr>
<tr valign="top">
<td style="" align=""><font face="Verdana" size="2" color="#000000"><b>8&#215;10 Event Prints</b></font><span style="color:red;"><small>*</small></span></td>
</tr>
<tr>
<td style="">
<select id="element_10" name="element_10" class="validate[required]">
<option value=""selected="selected">&#8211;</option>
<option value="0 - None">0 &#8211; None</option>
<option value="1 - $15.00">1 &#8211; $15.00</option>
<option value="2 - $25.00">2 &#8211; $25.00</option>
<option value="3 - $35.00">3 &#8211; $35.00</option>
<option value="4 - $45.00">4 &#8211; $45.00</option>
<option value="5 - $55.00">5 &#8211; $55.00</option>
<option value="6 - $65.00">6 &#8211; $65.00</option>
<option value="7 - $75.00">7 &#8211; $75.00</option>
<option value="8 - $85.00">8 &#8211; $85.00</option>
<option value="9 - $95.00">9 &#8211; $95.00</option>
<option value="10 - $105.00">10 &#8211; $105.00</option>
</select>
<div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div>
</td>
</tr>
<tr valign="top">
<td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Event Mugs</b></font><span style="color:red;"><small>*</small></span></td>
</tr>
<tr>
<td style="">
<select id="element_11" name="element_11" class="validate[required]">
<option value=""selected="selected">&#8211;</option>
<option value="0 - None">0 &#8211; None</option>
<option value="1 - $10.00">1 &#8211; $10.00</option>
<option value="2 - $20.00">2 &#8211; $20.00</option>
<option value="3 - $30.00">3 &#8211; $30.00</option>
<option value="4 - $40.00">4 &#8211; $40.00</option>
<option value="5 - $50.00">5 &#8211; $50.00</option>
<option value="6 - $60.00">6 &#8211; $60.00</option>
<option value="7 - $70.00">7 &#8211; $70.00</option>
<option value="8 - $80.00">8 &#8211; $80.00</option>
<option value="9 - $90.00">9 &#8211; $90.00</option>
<option value="10 - $100.00">10 &#8211; $100.00</option>
</select>
<div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div>
</td>
</tr>
<tr valign="top">
<td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Event Key Chains</b></font><span style="color:red;"><small>*</small></span></td>
</tr>
<tr>
<td style="">
<select id="element_12" name="element_12" class="validate[required]">
<option value=""selected="selected">&#8211;</option>
<option value="0 - None">0 &#8211; None</option>
<option value="1 - $5.00">1 &#8211; $5.00</option>
<option value="2 - $10.00">2 &#8211; $10.00</option>
<option value="3 - $15.00">3 &#8211; $15.00</option>
<option value="4 - $20.00">4 &#8211; $20.00</option>
<option value="5 - $25.00">5 &#8211; $25.00</option>
<option value="6 - $30.00">6 &#8211; $30.00</option>
<option value="7 - $35.00">7 &#8211; $35.00</option>
<option value="8 - $40.00">8 &#8211; $40.00</option>
<option value="9 - $45.00">9 &#8211; $45.00</option>
<option value="10 - $50.00">10 &#8211; $50.00</option>
</select>
<div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana"></font></small></div>
</td>
</tr>
<tr valign="top">
<td style="" align=""><font face="Verdana" size="2" color="#000000"><b>Customer Notes</b></font><span style="color:red;"><small></small></span></td>
</tr>
<tr>
<td style=""><textarea id="element_13" name="element_13" cols="30" rows="10" class="validate[optional] "></textarea>
<div style="padding-bottom:8px;color:#000000;"><small><font face="Verdana">Once your order form is submitted, you will be<br />sent a proof and contacted with our payment<br />options. </font></small></div>
</td>
</tr>
<tr>
<td colspan="2">
<table cellpadding="5" cellspacing="0" bgcolor="#ffffff" width="100%">
<tr bgcolor="#ffffff">
<td colspan="2"><font color="#ffffff" face="Verdana" size="2"><b>Image Verification</b></font></td>
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<tr>
<td style="padding:2px; width:100px;"><img id="captcha_image" src="http://www.emailmeform.com/builder/captcha/index/22a14ae93a10282fbc728584e3dba37a" alt="captcha"></td>
<td valign="top">
<div><font color="#ffffff">Please enter the text from the image</font>:<br />
<input type="text" id="captcha_code" name="captcha_code" maxlength="10" size="10" class="validate[required,funcCall[valid_captcha]]"  />[<a id="captcha_code_refresh" href="javascript:void(0);" onclick="document.getElementById('captcha_image').src = 'http://www.emailmeform.com/builder/captcha/index/'+Math.random();get_valid_captcha();return false;">Refresh Image</a>][<a id="captcha_code_about" href="javascript:void(0);" onclick="window.open('http://www.emailmeform.com/captcha-instruction.html','_blank','width=400, height=500, left=' + (screen.width-450) + ', top=100');return false;">What's This?</a>]</div>
</td>
</tr>
</table>
</td>
</tr>
<tr>
<td colspan="2" align="center">
<input name="element_counts" value="14" type="hidden" />
<input  value="Send email" type="submit" /></td>
</tr>
</table>
</form>
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