<?xml version="1.0" encoding="UTF-8"?>

<form url="registration.php"
 window="_self"
 method="POST"
 fontname="MS Sans Serif"
 width="375"
 height="550"
 bkcolor="0xFFFFFF"
 outlinecolor="0xFFFFFF"
 fontcolor="0x000000"
 themecolor="0xFFFF99"
 fontcolor2="#000000"
 bkcolor2="#FFFFFF"
 includeresults="false"
 emailuser="false"
 reqmessage="One or More Fields are Required"
 autoresponse=""
 transition="0">

<hidden
 name="mailto"
 value="you;yourdomain=com"
></hidden>

<hidden
 name="subject"
 value=""
></hidden>

<textinput
 name="My Input Box 1"
 x="4"
 y="24"
 w="144"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
>
</textinput>

<textinput
 name="My Input Box 2"
 x="160"
 y="24"
 w="175"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
>
</textinput>

<textinput
 name="My Input Box 3"
 x="4"
 y="76"
 w="144"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
>
</textinput>

<textinput
 name="My Input Box 4"
 x="160"
 y="76"
 w="175"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
>
</textinput>

<textinput
 name="My Input Box 5"
 x="4"
 y="208"
 w="146"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
>
</textinput>

<textinput
 name="My Input Box 6"
 x="172"
 y="208"
 w="178"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
>
</textinput>

<radiobutton
 name="My Radio Button 1"
 x="12"
 y="476"
 w="140"
 h="19"
 label="Consumer Collections"
 labelPos="right"
 groupname="Group 1"
 value="radiobutton1"
  fontsize="12"
  fontname="Arial"
  fontcolor="0x000000"
></radiobutton>

<radiobutton
 name="My Radio Button 2"
 x="12"
 y="444"
 w="149"
 h="19"
 label="Commercial Collections"
 labelPos="right"
 groupname="Group 1"
 value="radiobutton1"
  fontsize="12"
  fontname="Arial"
  fontcolor="0x000000"
></radiobutton>

<radiobutton
 name="My Radio Button 3"
 x="208"
 y="448"
 w="130"
 h="19"
 label=" Please send invoice"
 labelPos="right"
 groupname="Group 1"
 value="radiobutton1"
  fontsize="12"
  fontname="Arial"
  fontcolor="0x000000"
></radiobutton>

<radiobutton
 name="My Radio Button 4"
 x="208"
 y="476"
 w="102"
 h="19"
 label=" Payment made"
 labelPos="right"
 groupname="Group 1"
 value="radiobutton1"
  fontsize="12"
  fontname="Arial"
  fontcolor="0x000000"
></radiobutton>

<textinput
 name="My Input Box 7"
 x="4"
 y="304"
 w="305"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 emailbox="true"
>
</textinput>

<submitbutton
 name="Submit Button 1"
 x="124"
 y="524"
 w="100"
 h="20"
 label="Submit"
 fontname="Arial"
 fontcolor="0x000000"
  fontsize="12"
 isbrowse="f"
></submitbutton>

<textinput
 name="My Input Box 9"
 x="0"
 y="0"
 w="2"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
>
</textinput>

<textinput
 name="My Input Box 10"
 x="4"
 y="120"
 w="329"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
>
</textinput>

<textinput
 name="My Input Box 11"
 x="4"
 y="148"
 w="328"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
>
</textinput>

<textinput
 name="My Input Box 8"
 x="4"
 y="252"
 w="175"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
>
</textinput>

<radiobutton
 name="My Radio Button 5"
 x="16"
 y="368"
 w="135"
 h="19"
 label="I have read and agree"
 labelPos="right"
 groupname="Group 1"
 value="radiobutton1"
  fontsize="12"
  fontname="Arial"
  fontcolor="0x000000"
></radiobutton>

<label
 name="My Text 1"
 x="24"
 y="4"
 w="70"
 h="16"
 text="First name:"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 2"
 x="160"
 y="4"
 w="73"
 h="16"
 text="Last name: "
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 3"
 x="4"
 y="56"
 w="135"
 h="16"
 text="Company/Association:"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 4"
 x="160"
 y="60"
 w="83"
 h="16"
 text="Title/Position:"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 5"
 x="4"
 y="188"
 w="92"
 h="16"
 text="State/Province:"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 6"
 x="176"
 y="188"
 w="53"
 h="16"
 text="Country:"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 7"
 x="12"
 y="420"
 w="142"
 h="16"
 text="Select your program: "
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 8"
 x="220"
 y="420"
 w="104"
 h="16"
 text="Paid or invoice:"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 9"
 x="4"
 y="280"
 w="97"
 h="16"
 text="e-mail address"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 11"
 x="4"
 y="104"
 w="56"
 h="16"
 text="Address:"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 10"
 x="8"
 y="232"
 w="96"
 h="16"
 text="Postal/Zip Code"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

<label
 name="My Text 12"
 x="16"
 y="348"
 w="307"
 h="16"
 text="I have read and agree to terms of PACE Program."
 fontbold="bold"
 fontitalic="italic"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="13"
></label>

</form>