Currant Media Multi-Media Web Design, CD-ROM & Print Design

<body bgcolor="#F8F1DD"><table width="100%" cellpadding="0" cellspacing="0" border="0" bgcolor="#999999" height="20"> <tbody> <tr> <td height="18" bgcolor="#636563"><table width="727" height="18" border="0" cellpadding="0" cellspacing="0" bgcolor="#999999"> <tbody> <tr> <td width="222" height="18" align="left" nowrap="1"bgcolor="#636563"> <a class="lnk_mh" href="Services"><b></b></a> </td> <td width="505" height="18" align="right" nowrap="1" bgcolor="#636563"><a class="lnk_mh" href="http://www.currantmedia.com"><b><font face="verdana,arial,helvetica" color="White" size="1">Home</font></b></a><a class="lnk_mh" href="history/about.html"><b><font face="verdana,arial,helvetica" color="White" size="1"><img src="images/headerSep.gif" align="middle" border="0" height="15" width="12">Currant Media History</font></b></a><a class="lnk_mh" href="Services"><b><font face="verdana,arial,helvetica" color="White" size="1"><img src="images/headerSep.gif" align="middle" border="0" height="15" width="12">Services</font></b></a><a class="lnk_mh" href="#"><b><font face="verdana,arial,helvetica" color="White" size="1"><img src="images/headerSep.gif" align="middle" border="0" height="16" width="10"></font></b></a><a class="lnk_mh" href="contact.htm"><b><font face="verdana,arial,helvetica" color="White" size="1">Contact</font></b></a><a class="lnk_mh" href="portfolio"><b><font face="verdana,arial,helvetica" color="White" size="1"><img src="images/headerSep.gif" align="middle" border="0" height="15" width="12">Portfolio</font></b></a><img src="images/headerSep.gif" align="middle" border="0" height="15" width="12"><a class="lnk_mh" href="#"><b><font face="verdana,arial,helvetica" color="White" size="1">Site Map</font></b></a> </td> </tr> </tbody> </table></td> </tr> <tr> <td height="2" colspan="3" bgcolor="White"><img src="images/spacer.gif" border="0" height="1" width="1"></td> </tr> </tbody> </table><table width="100%" cellpadding="0" cellspacing="0" border="0" bgcolor="#013B82"> <tbody> <tr> <td><table width="672" cellpadding="0" cellspacing="0" border="0"> <tbody> <tr> <td rowspan="2" width="150"><img src="images/CurrantLOGO.gif" width="149" height="57"></td> <td width="522" height="37" align="right" valign="middle"><span class="txt_mhsegprefix"><b><font face="arial,helvetica" color="#99FFFF" size="2"> CURRANT MEDIA CONTACT FORM</font></b></span></td> </tr> <tr> <td height="20" align="right"><img src="images/spacer.gif" border="0" height="1" width="1"> </td> </tr> </tbody> </table></td> </tr> </tbody> </table> <table width="672" border="0" cellspacing="0" cellpadding="0"> <tr> <td width="269" valign="top"><blockquote> <p class="style1">Fill out our form for a free SiteXpress Website!*</p> <h4 align="left" class="paragraph">Currant Media<br> Corporate Office</h4> <p class="paragraph">755 W. State Road 434<br> Longwood, FL 32750</p> <p class="paragraph">Fax <strong>407-650-3257</strong><br> Phone <strong>407-574-2066</strong> <br> Out of State <strong>1-87-RELIANT4</strong></p> <strong>Mike Jacobs</strong><br> CEO<br> <a href="mailto:mcjake@currantmedia.com">mcjake@currantmedia.com</a> <p><strong>Julia Jacobs</strong><br> President<br> <a href="mailto:jjacobs@currantmedia.com">jjacoobs@currantmedia.com</a></p> <p><strong>Chuck Calio</strong><br> Self-Relient™ Marketing Specialist, <em>MBA</em><br> <a href="mailto:ccalio@currantmedia.com">chuck@currantmedia.com</a></p> <p><strong>Billing</strong>   <br> <a href="mailto:billing@currantmedia.com">billing@currantmedia.com </a></p> <p>* Once contact information is given via the form, Currant Media will send the login and password to build your free SiteXpress Website on our hosting server. You will have access to your site along with a SiteXpress hosting account for a month.</p> </blockquote></td> <td width="403" valign="top"><form action="/cgi-sys/formmail.pl" method="post"> <table width="389"> <tr> <td width="80" height="19">Name</td> <td colspan="2"><input name="recipient" type="hidden" value="form@currantmedia.com"> <input type=hidden name="env_report" value="REMOTE_ADDR,REMOTE_HOST,HTTP_USER_AGENT"> <input name="subject" type="hidden" value="Currant Media Contact Form"> <input name="redirect" type="hidden" id="redirect" value="http://currantmedia.com/thanks.html"> <input type=hidden name="required" value="realname,email,interest,contact"> <input name="realname" type="text" id="realname" size="30" maxlength="30"></td> </tr> <tr> <td>Email</td> <td colspan="2"><input name="email" type="text" id="email" size="30" maxlength="30"></td> </tr> <tr> <td>Company</td> <td colspan="2"><input name="company" type="text" id="company" size="30" maxlength="30"></td> </tr> <tr> <td>Job Title </td> <td colspan="2"><input name="title" type="text" id="title" size="30" maxlength="30"></td> </tr> <tr> <td>Address</td> <td colspan="2"><input name="address" type="text" id="address" size="40" maxlength="40"></td> </tr> <tr> <td>City</td> <td colspan="2"><input name="city" type="text" id="city" size="30" maxlength="30"></td> </tr> <tr> <td>State</td> <td colspan="2"><input name="state" type="text" id="state" size="2" maxlength="2"></td> </tr> <tr> <td>Zip</td> <td colspan="2"><input name="zip" type="text" id="zip" size="5" maxlength="5"></td> </tr> <tr> <td>Country</td> <td colspan="2"><input name="country" type="text" id="country" size="30" maxlength="30"></td> </tr> <tr> <td>Fax</td> <td colspan="2"><input name="fax" type="text" id="fax" size="20" maxlength="20"></td> </tr> <tr> <td>Phone</td> <td colspan="2"><input name="phone" type="text" id="phone" size="20" maxlength="20"></td> </tr> <tr> <td height="91" valign="top">Interested In: </td> <td colspan="2"><input name="interest" type="checkbox" id="interest" value="webDesign"> Web Design<br> <input name="interest" type="checkbox" id="interest" value="print"> Print <br> <input name="interest" type="checkbox" id="interest" value="CDROM"> CD-ROM / DVD Production <br> <input name="interest" type="checkbox" id="interest" value="hosting"> Hosting <br> <input name="interest" type="checkbox" id="interest" value="consulting"> Consulting <br> <input name="interest" type="checkbox" id="interest" value="selfReliantMarketing"> Self Reliant Marketing </td> </tr> <tr> <td height="32" valign="top">Contact By: </td> <td colspan="2"><input name="contact" type="checkbox" id="contact" value="phone"> Phone<br> <input name="contact" type="checkbox" id="contact" value="mail"> Mail <br> <input name="contact" type="checkbox" id="contact" value="email"> Email </td> </tr> <tr> <td valign="top">Comments:</td> <td colspan="2" align="center"><textarea name="comment" cols="35" rows="5" id="comment"></textarea></td> </tr> <tr> <td> </td> <td width="114"><input type="submit" name="Submit" value="Submit"></td> <td width="179"><input type="reset" name="Reset" value="Reset"></td> </tr> </table> </form></td> </tr> </table> <table width="672" border="0" cellpadding="0" cellspacing="0"> <tr> <td> <div align="center"><font face="arial,helvetica" size="1">© <span class="parasmall"><font face="arial,helvetica" size="1">2006</font></span> Currant Media L.C.<br> </font></div></td> </tr> </table></body>