{*$product.pid*}
{if $current_page == 'product'}
{*$smarty.request.url*}
{**$userdata|@print_r**}
<script language="javascript" type="text/javascript">
var countriesStates = {$countries_states};
{literal}
$(document).ready(function(){
setCountriesStates(
{/literal}
"#billing_country_quote", "{$form.country}",
"#billing_state_quote", "{$form.state}",
"#billing_province_quote", "{$form.province|htmlspecialchars}",
countriesStates
{literal}
);
});
{/literal}
</script>
<div id="new-request-a-quote" class="invisible">
<div class="panel-product-request-quote panel clearfix {class file=$smarty.template editable=true draggable=true}">
<!--<h4 class="{class file=$smarty.template editable=true}">Request a Quote</h4>  -->
<div class="content {class file=$smarty.template editable=true}" style="margin:0;padding:0;">
<table width="100%" cellpadding="0" cellspacing="0" border="0">
<tr><td>
<table width="100%" cellpadding="0" cellspacing="1" border="0" class="BoxFrame">
<tr><td class="BoxContent" style="padding:15px 0px 15px 0px;">
<div id="pk_quote_thanks" style="visiblity:hidden;display:none;">
<p style="font-family:'verdana', Arial, Helvetica, sans-serif !important;font-size: 12px !important;">Thank You, <br><br>
Your request has been sent. You will receive a quotation within 24 hours.<br><br>
If your quote request is urgent, call 1-518-218-7676<br><br>
<a href="{$url_http}?index.php"><font color=blue><b>Click here to return to Home Page</font></b></a><br><br>
{*$product|print_r*}
<a href="{$product.url}"><font color=blue><b>Click here to return to Product Page</b></a>
</p>
</div>
<div id="pk_quote_form">
<TABLE width="100%" border="0" cellpadding="5" cellspacing="5" align="center" style="padding-left:8px;">
<TR>
<TD align="left">
{if $auth_ok != "yes"}
<p style="color:#000000;font-family:'verdana', Arial, Helvetica, sans-serif !important;font-size: 12px !important;padding-bottom:15px;">
<b>Just complete the form below and we will reply within 24 hours.  Thanks!</b><br>
Have an account already? <a href="{$url_https}p=login"> <span style="color:blue">LOGIN</span></a>
or <a href="{$url_https}p=signup"><span style="color:blue"> Create Account </span></a>and you won&rsquo;t need to fill out this form.  You can also Save Searches, Receive New Product and Price Drop Alerts.</p>
{/if}
{if count($errmsg)> 0}
<font style="color:red;">Some errors were found. Please correct these errors and submit the form again.</font>
<br/><br/>
{/if}
<TABLE width="100%" border="0" cellpadding="5" cellspacing="5">
<input type="hidden" id="formaction" name="formaction" value="post" />
<input type="hidden" name="pid" id="pid" value="{$product.pid}" />
<TR>
<TD align="left" class="pk1" colspan="2">
<span  style="color:red;">*</span> - required field 
</TD>
</TR>
<TR>
<TD class="pk1" align="right">
<span  style="color:red;">*</span>
{if $errmsg.company != ''}
<font color=red>Company:</font>
{else}
<font class="msg-notice"><b>Company:</b></font>
{/if}
</TD>
<TD>
<INPUT type="text" name="company" id="company" size="25" class="formTextbox" value="{$userdata.company|htmlspecialchars}" 
style="width:150px;"
>
</TD>
</TR>
<TR>
<TD class="pk1" align="right">
<span  style="color:red;">*</span>
{if $errmsg.fname != ''}
<font color=red>First Name:</font>
{else}
<font class="msg-notice"><b>First Name:</b></font>
{/if}
</TD>
<TD align="left">
<INPUT type="text" name="fname" id="fname" size="25" class="formTextbox" value="{$userdata.fname|htmlspecialchars}" 
style="width:150px;"
>
</TD>
</TR>
<TR>
<TD class="pk1" align="right">
<FONT color="red">*</FONT>
{if $errmsg.lname != ''}
<font color=red>Last Name:</font>
{else}
<font class="msg-notice"><b>Last Name:</b></font>
{/if}
</TD>
<TD align="left">
<INPUT type="text" name="lname" id="lname" size="25" class="formTextbox" value="{$userdata.lname|htmlspecialchars}" 
style="width:150px;"
>
</TD>
</TR>
<TR>
<TD class="pk1" align="right">
<FONT color="red">*</FONT>
{if $errmsg.email != ''}
<font color=red>Email:</font>
{else}
<font class="msg-notice" align="top"><b>Email:</b></font>
{/if}
</TD>
<TD align="left">
<INPUT type="text" name="email" id="email" size="20" class="formTextbox" value="{$userdata.email|htmlspecialchars}" style="width:150px;">
</TD>
</TR>
<TR>
<TD class="pk1" align="right">
<FONT color="red">*</FONT>
{if $errmsg.phone != ''}
<font color=red>Phone:</font>
{else}
<font class="msg-notice"><b>Phone:</b></font>
{/if}
</TD>
<TD align="left">
<INPUT type="text" name="phone" id="phone" size="20" class="formTextbox" value="{$userdata.phone|htmlspecialchars}"
style="width:150px;">
</TD>
</TR>
<TR>
<TD class="pk1" align="right">
<font class="msg-notice"><b>Address 1:</b></font>
</TD>
<TD align="left">
<INPUT type="text" name="addr1" id="addr1" size="25" class="formTextbox" value="{$userdata.address1|htmlspecialchars}"
style="width:150px;">
</TD>
</TR>
<TR>
<TD class="pk1" align="right">
<font class="msg-notice"><b>Address 2:</b></font>
</TD>
<TD align="left">
<INPUT type="text" name="addr2" id="addr2" size="25" class="formTextbox" value="{$userdata.address2|htmlspecialchars}"
style="width:150px;">
</TD>
</TR>
<TR>
<TD class="pk1" align="right">
{if $errmsg.city != ''}
<font color=red>City/Town:</font>
{else}
<font class="msg-notice"><b>City/Town:</b></font>
{/if}
</TD>
<TD align="left">
<INPUT type="text" name="city" id="city" class="formTextbox" value="{$userdata.city|htmlspecialchars}" style="width:150px;">
                             </TD>
</TR>
                       <tr>
<TD class="pk1" align="right">
<FONT color="red">*</FONT>
{if $errmsg.country != ''}
<font color=red>Country:</font>
{else}
<font class="msg-notice"><b>Country:</b></font>
{/if}
</TD>
<td>
<div id="billing_country_quote" class="field required clearfix">
<select style="margin-left: 0px;float:left;width: 155px;" id="billing_country_select" name="OfficeCountry93259">
</select>
</div>
</td>
</tr>
<tr>
<td align="right">
<label style="color: black;font-weight: bold;" for="billing_state_select">{$msg.billing.state_province} / Territory</label>
</td>
<td>
<div id="billing_state_quote" id="div_billing_address_state">
<select style="margin-left: 0px;float:left;width: 155px;" id="billing_state_select" name="OfficeState93262"></select></div>
<div id="billing_province_quote" class="field required invisible clearfix" id="div_billing_address_province">
<input style="margin-left: 0px;float:left;width: 150px;" id="billing_province_input" maxlength="24" type="text" name="form[province]"/>
</div>
</td>
</tr>
</TD>
</TR>
<TR>
<TD class="pk1" align="right">
{if $errmsg.zip != ''}
<font color=red>Zip/Postal Code:</font>
{else}
<font class="msg-notice"><b>Zip/Postal Code:</b></font>
{/if}
</TD>
<TD align="left">
<INPUT type="text" name="zip" id="zip" size="7" maxlength="10" class="formTextbox" value="{$userdata.zip|htmlspecialchars}" style="width:150px;">
</TD>
</TR>
<TR>
<TD class="pk1" align="right" valign="top" width="207px">
<font class="msg-notice"><b>Comments or Questions:</b></font>
</TD>
<TD align="left">
<TEXTAREA name="description" id="description" rows="7" cols="20" style="height:95px;width:220px;">{$form.description|htmlspecialchars}</TEXTAREA>
</TD>
</TR>
<TR>
<TD class="pk1" align="center" colspan="2">
<br/>
<INPUT type="submit" name="save" value="Submit" class=formButton ID="request_quote_submit">
<INPUT type="reset" value="Rest" class=formButton ID="Button1">
</TD>
</TR>
</TD>
</TR></table>
<table>
</TABLE>
</TD>
</TR>
</TABLE>
</form>
</div>
<div id="output1" style="visibility:hidden;display:none;"></div>
{* ------------------------------------------------ *}
</td></tr>
</table>
</td></tr>
{*<td bgcolor="#FFFFFF">&nbsp;</td>*}
</table>
</div>
</div>
</div>
{/if}