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<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN""DTD/xhtml1-transitional.dtd"><html xmlns="http://www.w3.org/1999/xhtml"><head><title>ShuttleWorth</title><meta http-equiv="content-type" content="text/html; charset=utf-8" /><style media="all" type="text/css">@import "css/all.css";</style><script type="text/javascript" src="js/menu.js"></script></head><body><div id="main"><div class="white-border"><div id="header"><ul id="top-nav"><li><a href="#">Home</a></li><li><a href="#">Press</a></li><li><a href="#">Upcoming Tradeshows</a></li><li><a href="#" class="last">Contact Us</a></li></ul><ul id="main-navigation"><li><a href="#" class="btn1">Home</a></li><li><a href="#" class="btn2">Applications</a><div class="sub-nav"><div><span>Accumulation / Buffering<a href="#">Gentle handling</a><a href="#">Vertical</a><a href="#">Non Contact</a></span><span>Multi-Lane<a href="#">Multipacker</a><a href="#">Bi-Directional</a></span><span>Sortation<a href="#">Dyna-Guide</a><a href="#">Pattern Forming</a></span><span>Combining / Dividing<a href="#">Standard Combining</a><a href="#">Servo Combining</a><a href="#">Single Filing</a><a href="#">Dyna-Guide</a><a href="#">Pattern Forming</a></span><span>Indexing<a href="#">Smart Feeds</a><a href="#">Blade Stops</a></span><span>Positioning<a href="#">Stacking</a><a href="#">Robotic Interfacing</a><a href="#">Product Orientation</a></span><div class="clear"></div><span>Special Environments<a href="#">Clean</a><a href="#">Clean Class 100</a><a href="#">Cleaner Class 10</a><a href="#">Cleanest Class 1</a><a href="#">Hot/ Cold</a><a href="#">Abrasive</a><a href="#">Oily</a><a href="#">Corrosive</a><a href="#">Wet</a><a href="#">Radioactive</a><a href="#">Static Control</a><a href="#">Explosion Proof</a><a href="#">Electro Static Discharge</a></span><span>Unique Solutions<a href="#">Harringbone</a><a href="#">Waterfall</a><a href="#">Surface Configuration</a></span></div></div></li><li><a href="#" class="btn3">Markets we Serve</a></li><li><a href="#" class="btn4">Products</a><div class="sub-nav"><div><span>Accumulation / Buffering<a href="#">Gentle handling</a><a href="#">Vertical</a><a href="#">Non Contact</a></span><span>Multi-Lane<a href="#">Multipacker</a><a href="#">Bi-Directional</a></span><span>Sortation<a href="#">Dyna-Guide</a><a href="#">Pattern Forming</a></span><span>Combining / Dividing<a href="#">Standard Combining</a><a href="#">Servo Combining</a><a href="#">Single Filing</a><a href="#">Dyna-Guide</a><a href="#">Pattern Forming</a></span><span>Indexing<a href="#">Smart Feeds</a><a href="#">Blade Stops</a></span><span>Positioning<a href="#">Stacking</a><a href="#">Robotic Interfacing</a><a href="#">Product Orientation</a></span><div class="clear"></div><span>Special Environments<a href="#">Clean</a><a href="#">Clean Class 100</a><a href="#">Cleaner Class 10</a><a href="#">Cleanest Class 1</a><a href="#">Hot/ Cold</a><a href="#">Abrasive</a><a href="#">Oily</a><a href="#">Corrosive</a><a href="#">Wet</a><a href="#">Radioactive</a><a href="#">Static Control</a><a href="#">Explosion Proof</a><a href="#">Electro Static Discharge</a></span><span>Unique Solutions<a href="#">Harringbone</a><a href="#">Waterfall</a><a href="#">Surface Configuration</a></span></div></div></li><li><a href="#" class="btn5">Videos</a></li><li><a href="#" class="btn6">Product Literature</a></li><li><a href="#" class="btn7">Corporate Information</a></li></ul><div class="login-search-box"><form action="" class="search"><input type="text" class="text" /><input type="image" src="img/go-btn.gif" class="go" /></form><form action="" class="login"><input type="text" class="text" /><input type="text" class="text" /><input type="image" src="img/go-btn.gif" class="go" /></form></div></div><div class="header-images" id="client"><div class="visual"></div><div class="product-name">Registration Form</div></div><div id="breadcrumps">You are here: <a href="#">Home</a> > <a href="#">Administrative Area</a> > <a href="#">Create New client</a></div><div id="content"><div class="left-column"><h2>Administrative area</h2><ul><li><a href="#">Client Listing</a></li><li><a href="#">Client Creation</a></li><li><a href="#">Logout</a></li></ul></div><div class="right-column"><div class="top-box"><h2 class="product-name">Request Info</h2></div><!--<div class="page-content-static"> --><div class="clear"></div><div class="map"><a <em>id="locUSA" href="#" class="link1">Shuttleworth, Inc.<br />World Headquarters<br />10 Commercial Rd.<br />Huntigton, IN 46750<br />USA</a><a <em>id="locEurope" href="#" class="link2">Shuttleworth Europe N.V.<br />Xavier de Cocklaan 86-88, 9831<br />Sint Martens Latern, Belgium</a><a <em>id="locAsia" href="#" class="link3">Shuttleworth Southeast Asia<br />Kuala Lumpur, Malaysia</a></div><p>Please enter your information below</p><form action="" method="POST"><input type="hidden" name="_action_" value="contact_us"><input type="hidden" name="_action_tpl_" value="contact_us/contact_us"><ul class="r-form">   <li class="f2f2f2"><label><span>Location:</span></label>        <select id="location">      <option value="USA">USA</option><option value="Europe">Europe</option><option value="Asia">Asia</option></select></li>   <li><label><span>Name:</span></label><input type="text" name="_input_name" value="" class="text"/></li>   <li class="f2f2f2"><label><span>Title:</span></label><input type="text" name="_input_title" value="" class="text"/></li>   <li><label><span>Company:</span></label><input type="text" name="_input_company" value="" class="text"/></li>   <li class="f2f2f2"><label><span>Address:</span></label><input type="text" name="_input_address" value="" class="text"/></li>   <li><label><span>City:</span></label><input type="text" name="_input_city" value="" class="text"/></li>   <li class="f2f2f2"><label><span>State:</span></label><input type="text" name="_input_state" value="" class="text"/></li>   <li><label><span>Postal Code:</span></label><input type="text" name="_input_postal_code" value="" class="text"/></li>   <li class="f2f2f2"><label><span>Country:</span></label><input type="text" name="_input_country" value="" class="text"/></li>   <li><label><span>Phone:</span></label><input type="text" name="_input_phone" value="" class="text"/></li>   <li class="f2f2f2"><label>Fax:</label><input type="text" name="_input_fax" value="" class="text"/></li>   <li><label><span>E-Mail:</span></label><input type="text" name="_input_email" value="" class="text"/></li>   <li class="f2f2f2"><label>Website:</label><input type="text" name="_input_website" value="" class="text"/></li>   <li>      <div>         Which best describes your department?      </div>     <select name="_input_department">      <option value="Engineering" >Engineering</option><option value="Management" >Management</option><option value="Manufacturing"  >Manufacturing</option><option value="Purchasing" >Purchasing</option><option value="Other" >Other</option></select></li>   <li class="f2f2f2">      <div>         Which best describes your interests?      </div>      <select name="_input_interest">      <option value="Direct End User" >Direct End User</option><option value="Manufacturing Rep" >Manufacturing Rep</option><option value="Dealer" >Dealer</option><option value="OEM" >OEM</option><option value="Competitor" >Competitor</option><option value="Student" >Student</option>  </select>   </li>   <li>      <div>         Would you like to receive our Corporate CD?      </div><input type="radio" name="_input_like_receive_cd"  checked  value="yes" class="r"/><label class="small">Yes</label><input type="radio" name="_input_like_receive_cd"  value="no" class="r"/><label class="small">No</label>   </li>   <li class="f2f2f2">      <div>         Would you like to receive our quarterly newsletter?      </div><input type="radio" name="_input_like_receive_newsletter"  checked  value="yes" class="r"/><label class="small">Yes</label><input type="radio" name="_input_like_receive_newsletter"  value="no" class="r"/><label class="small">No</label>   </li>   <li>      <div>         Would you like your local Sales Engineer to call?      </div><input type="radio" name="_input_like_call"  checked  value="yes" class="r"/><label class="small">Yes</label><input type="radio" name="_input_like_call"  value="no" class="r"/><label class="small">No</label>   </li>   <li class="f2f2f2">      <div>         How did you find out about us?      </div>      <select name="_input_find_out">      <option value="Past/Existing Customer" >Past/Existing Customer</option>        <option value="Print Media" >Print Media</option>        <option value="Referral" >Referral</option>        <option value="Shows" >Shows</option>        <option value="Another Web Site/Search Engine" >Another Web Site/Search Engine</option>      </select>   </li>   <li class="big"><label>Comments:</label><textarea cols="" rows="" name="_input_comments"></textarea></li></ul><br /><div class="indic">   <span>Indicates Required Field</span></div><input type="submit" value="Submit" class="grey-button"/> <input type="submit" value="Reset" class="grey-button"/></form> <!-- </div> --></div></div><div id="footer"><div><ul><li><ul><li><a href="#">Home</a></li><li><a href="#">Applications</a></li><li><a href="#">Markets we Serve</a></li><li><a href="#">Products</a></li><li><a href="#">Videos</a></li><li><a href="#">Product Literature</a></li><li><a href="#">Press</a></li><li><a href="#">Upcoming Tradeshows</a></li><li class="last"><a href="#">Contact Us</a></li></ul></li><li><ul><li><a href="#">Site Map</a></li><li><a href="#">German</a></li><li><a href="#">French</a></li><li><a href="#">Dutch</a></li><li class="last"><a href="#">Spanish</a></li></ul></li></ul><p>All Contents Copyright © 2005 Shuttleworth, Inc.</p></div></div></div></div></body></html>