[include css('error.css')];
[include css('products.css')];
[include css('front-product-page.css')];
[include css('more-info.css')];
[include css('contact.css')];

[html-page set-title("Contact Us")];

[include javascript('libraries/behaviour.js')];
[include javascript('libraries/magiclabel.js')];


<div id="product-container">
	<div id="product-info"
		<h4>Need to Contact Us for Your Sales or Service Needs?</h4>

			<ul>
				<li><strong>KPI Ultrasound, Inc.</strong></li>
				<li>887 Marlborough Ave						 </li>
				<li>Riverside, CA 92507						 </li>
				<li>Main Tel: 951 367 0872				 </li>
				<li>Tel (toll free): 888 88 IMAGE (46243)</li>
				<li>Fax: 951 367 0891					 </li>
			</ul>

			<p><a href="/contact/contact-spanish.html" title="Contact Page in Espanol">Contact Page in Espanol</a></p>
	</div>


	<div class="right">
		<script type="text/javascript" src="[path get('javascript')];/pages/kpi-contact.iota"></script>
	</div>

</div>

<div class="float-catch"></div>
<div id="more-info">

	<div style='display: [var error-display];; width: 450px;' class='error-group'>
		<div class="float-catch"></div>
		[var error-message];
		<div class="float-catch"></div>
	</div>

	<div class="float-catch"></div>

	<form id="contact-form" class="form" method="POST" action="" style='display: [var form-display];'>
		<input type="hidden" name="submitted" value="1">
		<input type="hidden" name="to" value="0">
		<input type="hidden" name="language" value="English">


		<div class="fieldOpt">
			<label for="name" id="name-label-static">Enter Your Name</label><br/>
			<!-- <label for="name" id="name-label" class="magiclabel">Name</label> -->
			<input type="text" name="name" id="name" class="magiclabel fwidth" value="[var name];">
			<div class="float-catch"></div>
		</div>


		<div class="fieldOr">
			<label for="company" id="company-label-static">Enter Your Company Name</label><br/>
			<!-- <label for="company" id="company-label" class="magiclabel">Company Name</label> -->
			<input type="text" name="company" id="company" class="magiclabel fwidth" value="[var company];">
			<div class="float-catch"></div>
		</div>


		<div class="fieldOpt">
			<label for="state" id="state-label-static">Enter Your State</label><br/>
			<label for="state" id="state-label" class="magiclabel ">State</label>
			<select name="state" id='state' title='State' class='fullwidth magiclabel state-width'>
				[htmlpage select-options('[var state];', '', [var state-option-params];)];
			</select>

			<div class="float-catch"></div>
		</div>
		
		<div class="fieldOr">
			<label for="international" id="international-label-static">International Countries</label><br/>
			<!-- <label for="international" id="international-label" class="magiclabel">International Countries</label> -->
			<input type="text" name="international" id="international" class="magiclabel fwidth" value="[var international];" >
			<div class="float-catch"></div>
		</div>

		<div class="fieldOpt">
			<label for="phone" id="phone-label-static">Enter Your Phone Number</label><br/>
			<!-- <label for="phone" id="phone-label" class="magiclabel">Phone Number</label> -->
			<input type="text" name="phone" id="phone" class="magiclabel fwidth" value="[var phone];" >
			<div class="float-catch"></div>
		</div>


		<div class="fieldOr">
			<label for="from" id="from-label-static">Enter Your Email Address</label><br/>
			<!-- <label for="from" id="from-label" class="magiclabel">Email Address</label> -->
			<input type="text" name="from" id="from" class="magiclabel fwidth" value="[var from];">
			<div class="float-catch"></div>
		</div>

		<div class="fieldOpt">
			<label for="interests" id="interests-label-static">Product Interests</label><br/>
			<!-- <label for="interests" id="interests-label" class="magiclabel ">Product Interests</label> -->
			<select name="interests" id='interests' title='interests' class='fullwidth magiclabel state-width'>
				[htmlpage select-options('[var interests];', 'Ultrasound', 'CT', 'MRI', 'Probes', 'Parts', 'Service')];
			</select>
		</div>

		<div class="field formhighlighter">
			<label for="message" id="message-label">Message</label><br>
			<textarea name="message" id="message" rows="10" class="fwidth" style="width:521px;">[var message];</textarea>
			<div class="float-catch"></div>
		</div>

		<div class="field">
			<INPUT type='image' name="submit" src="/images/contact/submit.gif" title="Submit" alt='submit' class="actionbtn">
			<INPUT type='image' src="/images/contact/reset.gif" title="reset" alt='reset' class='otherbtn'
				onclick='(document.getElementById("contact-form")).reset(); return false;'>
			<br/>

		</div>
	</form>

	<div style='display: [var notice-display];' class='error-group'>
		<p>To prevent spam, you may only sumbit an application once every 5 minutes.  You will
		be able to submit another application at <em>[var notice-open-time];</em>.
		</p>
	</div>
</div>