<p><strong><span style="color: #000066;"><span style="font-size: medium;">Contact Us - Request for Rental Proposal </span></span></strong></p>
<p><strong><span style="color: #000066;"><span style="font-size: medium;"><br /></span></span></strong></p>
<form action="http://www.bluehost.com/bluemail" enctype="multipart/form-data" method="post"> <input name="sendtoemail" type="hidden" value="rentals@conferencesystems.com" /> <input name="redirect" type="hidden" value="http://test.conferencesystems.com/rfpsubmit" /> <input name="mailfrom" type="hidden" value="website@conferencesystems.com" /> <input name="subject" type="hidden" value="Rentals RFP Request" /> 
<table style="border: 0pt none; padding: 2px; border-collapse: collapse; font-size: 10pt; height: 569px; width: 100%;" border="0" cellpadding="2">
<tbody>
<tr>
<td>&nbsp;</td>
<td><span style="color: #000066;"><strong><span style="font-size: medium;">Client Information</span></strong></span></td>
<td>&nbsp;</td>
</tr>
<tr>
<td style="width: 30%; text-align: right;">Name</td>
<td style="width: 30%; text-align: left;"><input name="ClientName" size="30" type="text" tabindex="1" /></td>
<td style="width: 35%;">&nbsp;</td>
</tr>
<tr>
<td style="width: 30%; text-align: right;">Title</td>
<td style="width: 30%; text-align: left;"><input name="ClientTitle" size="30" type="text" tabindex="2" /></td>
<td style="width: 30%; text-align: left;"><input name="SIEquipment" type="checkbox" tabindex="31" />Simultaneous Interpretation Equipment</td>
</tr>
<tr>
<td style="width: 30%; text-align: right;">Company</td>
<td style="width: 30%; text-align: left;"><input name="ClientCompany" size="30" type="text" tabindex="3" /></td>
<td style="width: 30%; text-align: left;">&nbsp;</td>
</tr>
<tr>
<td style="width: 30%; text-align: right;">Address Line 1</td>
<td style="width: 30%; text-align: left;"><input name="ClientAddress1" size="30" type="text" tabindex="4" /></td>
<td style="width: 30%; text-align: left;"><input name="SIInterpreters" type="checkbox" tabindex="32" />Simultaneous Interpreters</td>
</tr>
<tr>
<td style="width: 30%; text-align: right;">Address Line 2</td>
<td style="width: 30%; text-align: left;"><input name="ClientAddress2" size="30" type="text" tabindex="5" /></td>
<td style="width: 30%; text-align: left;">&nbsp;</td>
</tr>
<tr>
<td style="width: 30%; text-align: right;">City</td>
<td style="width: 30%; text-align: left;"><input name="ClientState" size="30" type="text" tabindex="6" /></td>
<td style="width: 30%; text-align: left;"><input name="ConfMics" type="checkbox" tabindex="33" />Conference Microphones</td>
</tr>
<tr>
<td style="width: 30%; text-align: right;">State</td>
<td style="width: 30%; text-align: left;"><input name="ClientState" size="4" type="text" tabindex="7" /></td>
<td style="width: 30%; text-align: left;">&nbsp;</td>
</tr>
<tr>
<td style="width: 30%; text-align: right;">Zip</td>
<td style="width: 30%; text-align: left;"><input name="ClientZip" size="30" type="text" tabindex="8" /></td>
<td style="width: 30%; text-align: left;"><input name="ARS" type="checkbox" tabindex="34" />CSInteractive Audience Response System</td>
</tr>
<tr>
<td style="width: 30%; text-align: right;">Phone</td>
<td style="width: 30%; text-align: left;"><input name="ClientPhone" size="30" type="text" tabindex="9" /></td>
<td style="width: 30%; text-align: left;">&nbsp;</td>
</tr>
<tr>
<td style="width: 30%; text-align: right;">Fax</td>
<td style="width: 30%; text-align: left;"><input name="ClientFax" size="30" type="text" tabindex="10" /></td>
<td style="width: 30%; text-align: left;"><input name="OtherReq" type="checkbox" tabindex="35" />Other (Please describe below)</td>
</tr>
<tr>
<td style="width: 30%; text-align: right;">Email</td>
<td style="width: 30%; text-align: left;"><input name="ClientEmail" size="30" type="text" tabindex="11" /></td>
<td style="width: 30%; text-align: left;">&nbsp;</td>
</tr>
<tr>
<td style="text-align: right;">Preferred Contact Method</td>
<td style="width: 30%; text-align: left;"><input name="ContactMethod" size="30" type="text" tabindex="11" /></td>
<td style="width: 30%; text-align: left;">&nbsp;</td>
</tr>
<tr>
<td style="height: 30px;" colspan="3">&nbsp;</td>
</tr>
<tr>
<td>&nbsp;</td>
<td><span style="color: #000066;"><strong><span style="font-size: medium;">Event Information</span></strong></span></td>
<td>&nbsp;</td>
</tr>
<tr>
<td style="width: 30%; text-align: right;">Event Name</td>
<td style="width: 30%; text-align: left;"><input name="ConfName" size="30" type="text" tabindex="12" /></td>
<td style="width: 30%; text-align: left;">&nbsp;</td>
</tr>
<tr>
<td style="width: 30%; text-align: right;">Facility Name</td>
<td style="width: 30%; text-align: left;"><input name="ConfFacility" size="30" type="text" tabindex="13" /></td>
<td style="width: 30%; text-align: left;">&nbsp;</td>
</tr>
<tr>
<td style="width: 30%; text-align: right;">Facility Location</td>
<td style="width: 30%; text-align: left;"><input name="ConfFacilityLocation" size="30" type="text" tabindex="14" /></td>
<td style="width: 30%; text-align: left;">&nbsp;</td>
</tr>
<tr>
<td style="width: 30%; text-align: right;">Number of Attendees</td>
<td style="width: 30%; text-align: left;"><input name="ConfAttendees" size="30" type="text" tabindex="15" /></td>
<td style="width: 30%; text-align: left;">&nbsp;</td>
</tr>
<tr>
<td style="width: 30%; text-align: right;">Number of Meeting Rooms</td>
<td style="width: 30%; text-align: left;"><input name="ConfMeetingRooms" size="30" type="text" tabindex="16" /></td>
<td style="width: 30%; text-align: left;">&nbsp;</td>
</tr>
<tr>
<td style="width: 30%; text-align: right;">Event Date Start</td>
<td style="width: 30%; text-align: left;"><input name="ConfDateStart" size="30" type="text" tabindex="17" /></td>
<td style="width: 30%; text-align: left;">&nbsp;</td>
</tr>
<tr>
<td style="width: 30%; text-align: right;">Event Date End</td>
<td style="width: 30%; text-align: left;"><input name="ConfDateEnd" size="30" type="text" tabindex="18" /></td>
<td style="width: 30%; text-align: left;">&nbsp;</td>
</tr>
<tr>
<td style="width: 30%; text-align: right;">Conference Languages</td>
<td style="width: 30%; text-align: left;"><input name="ConfLanguages" size="30" type="text" tabindex="19" /></td>
<td style="width: 30%; text-align: left;">&nbsp;</td>
</tr>
<tr>
<td style="text-align: right;">How did you hear about us?</td>
<td style="width: 30%; text-align: left;"><input name="How_Did_You_Hear_About_Us" size="30" type="text" tabindex="18" /></td>
<td style="width: 30%; text-align: left;">&nbsp;</td>
</tr>
<tr>
<td style="width: 30%; text-align: right;">Other Requirements<br /></td>
<td style="width: 30%; text-align: left;"><textarea cols="23" rows="3" name="Comments"></textarea></td>
<td style="width: 30%; text-align: left;">&nbsp;</td>
</tr>
<tr>
<td style="width: 100%; text-align: center;" colspan="3"><input type="submit" value="Submit" tabindex="50" /></td>
</tr>
</tbody>
</table>
</form>