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<!-- Locale=en_US -->
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  <!-- BOF: ./personal-templates/simple/business/layout/l59.wait -->


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<HTML>

<HEAD>


<META NAME="description" CONTENT="Large enough to serve you, small enough to care.">
<META NAME="Keywords"    CONTENT="propane,gas,fuel,buffalo,litter,quality,grill,holland,chillicothe">


<!-- business -->


<META HTTP-EQUIV="Content-Type" CONTENT="text/html; charset=UTF-8">
<META NAME="Generator" content="">
<!-- BOF: ./personal-templates/simple/themes.show -->


<!-- EOF: ./personal-templates/simple/themes.show -->


<!--<BASE HREF="http://lamiae.meccahosting.com/~a00035c5/order.html">-->
<TITLE>Place a Gas Order</TITLE></head>
<BODY  BGCOLOR="#FFFFFF"
 TEXT="#333333"

LEFTMARGIN="0" TOPMARGIN="0" RIGHTMARGIN="0" BOTTOMMARGIN="0"

 onLoad=""
 
 LINK="#660000"
 VLINK="#000000"
 ALINK="#000000"
>

  
      <!-- BOF: ./personal-templates/simple/business/layout/l59.layout --> 

<!-- html -->
<TABLE WIDTH="100%" height="100%" BORDER=0 CELLPADDING=0 CELLSPACING=0 align="center" valign="top" background="widgets/gen_1279.1.gif" bgcolor="#A24A1E">
    <TR>
       <TD WIDTH="100%" height="100%" align="center" valign="top" background="">
            <TABLE WIDTH="90%" BORDER=0 CELLPADDING=0 CELLSPACING=10 align="center" valign="top">
              <tr>
                <td width="100%" colspan="2">
                    <TABLE height="76" WIDTH="100%" BORDER=0 CELLPADDING=0 CELLSPACING=0 valign="top">
                       <tr>
                         <td width="687" height="76"><img src="widgets/gen_1267.1.gif" border=0 width=687 height=76 alt=""></td>
                         <td background="widgets/gen_1269.1.gif">&nbsp;</td>
                         <td width="14" height="76" align="right"><img src="widgets/gen_1270.1.gif" border=0 width=14 height=76 alt=""></td>
                       </tr>
                    </table>
                </td>
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              <tr>
                <td width="206" height="100%" valign="top">
                <TABLE WIDTH="206" height="100%" BORDER=0 CELLPADDING=0 CELLSPACING=0 valign="top">
                    <tr><td valign="top">
                      <TABLE WIDTH="206" BORDER=0 CELLPADDING=0 CELLSPACING=0 valign="top">
                         <tr>
                           <td colspan="3"><img src="widgets/gen_1288.1.gif" border=0 width=206 height=31 alt=""></td>
                         </tr>
                         <tr>
                           <td width="13" background="widgets/gen_1291.1.gif"><img src="images/spacer.png" width="13" height="1"></td>
                           <td bgcolor="#FCD8C7" valign="top">
                                            <a href="index.html" onMouseOver="document.images['img328'].src='widgets/gen_1296.1.gif'" onMouseOut="document.images['img328'].src='widgets/gen_1295.1.gif'"><img src="widgets/gen_1295.1.gif" alt="Intro" name="img328" border="0"></a><br>
                                            <a href="home.html" onMouseOver="document.images['img101'].src='widgets/gen_1298.1.gif'" onMouseOut="document.images['img101'].src='widgets/gen_1297.1.gif'"><img src="widgets/gen_1297.1.gif" alt="Home" name="img101" border="0"></a><br>
                                            <a href="history.html" onMouseOver="document.images['img117'].src='widgets/gen_1300.1.gif'" onMouseOut="document.images['img117'].src='widgets/gen_1299.1.gif'"><img src="widgets/gen_1299.1.gif" alt="History" name="img117" border="0"></a><br>
                                            <a href="serviceareas.html" onMouseOver="document.images['img119'].src='widgets/gen_1302.1.gif'" onMouseOut="document.images['img119'].src='widgets/gen_1301.1.gif'"><img src="widgets/gen_1301.1.gif" alt="Service Areas" name="img119" border="0"></a><br>
                                            <a href="hollandgrills.html" onMouseOver="document.images['img113'].src='widgets/gen_1304.1.gif'" onMouseOut="document.images['img113'].src='widgets/gen_1303.1.gif'"><img src="widgets/gen_1303.1.gif" alt="Holland Grills" name="img113" border="0"></a><br>
                                            <a href="newsandevents.html" onMouseOver="document.images['img106'].src='widgets/gen_1306.1.gif'" onMouseOut="document.images['img106'].src='widgets/gen_1305.1.gif'"><img src="widgets/gen_1305.1.gif" alt="News & Events" name="img106" border="0"></a><br>
                                            <a href="recipes.html" onMouseOver="document.images['img135'].src='widgets/gen_1310.1.gif'" onMouseOut="document.images['img135'].src='widgets/gen_1309.1.gif'"><img src="widgets/gen_1309.1.gif" alt="Recipes" name="img135" border="0"></a><br>
                                            <a href="order.html" onMouseOver="document.images['img191'].src='widgets/gen_1312.1.gif'" onMouseOut="document.images['img191'].src='widgets/gen_1333.1.gif'"><img src="widgets/gen_1333.1.gif" alt="Order Propane" name="img191" border="0"></a><br>
                                            <a href="payment1.html" onMouseOver="document.images['img183'].src='widgets/gen_1314.1.gif'" onMouseOut="document.images['img183'].src='widgets/gen_1313.1.gif'"><img src="widgets/gen_1313.1.gif" alt="Make A Payment" name="img183" border="0"></a><br>
                                            <a href="skytracker1.html" onMouseOver="document.images['img314'].src='widgets/gen_1569.1.gif'" onMouseOut="document.images['img314'].src='widgets/gen_1568.1.gif'"><img src="widgets/gen_1568.1.gif" alt="SkyTracker" name="img314" border="0"></a><br>
                                            <a href="buffalobuckshtml.html" onMouseOver="document.images['img111'].src='widgets/gen_4507.1.gif'" onMouseOut="document.images['img111'].src='widgets/gen_4483.1.gif'"><img src="widgets/gen_4483.1.gif" alt="Referral Program" name="img111" border="0"></a><br>
                                            <a href="insurance1.html" onMouseOver="document.images['img340'].src='widgets/gen_4494.1.gif'" onMouseOut="document.images['img340'].src='widgets/gen_4485.1.gif'"><img src="widgets/gen_4485.1.gif" alt="Regulator & Line Insurance" name="img340" border="0"></a><br>
                                            <a href="form.html" onMouseOver="document.images['img275'].src='widgets/gen_1318.1.gif'" onMouseOut="document.images['img275'].src='widgets/gen_1317.1.gif'"><img src="widgets/gen_1317.1.gif" alt="Survey" name="img275" border="0"></a><br>
                                            <a href="safetytips.html" onMouseOver="document.images['img121'].src='widgets/gen_1316.1.gif'" onMouseOut="document.images['img121'].src='widgets/gen_1315.1.gif'"><img src="widgets/gen_1315.1.gif" alt="Safety Tips" name="img121" border="0"></a><br>
                                            <a href="directions.html" onMouseOver="document.images['img104'].src='widgets/gen_1320.1.gif'" onMouseOut="document.images['img104'].src='widgets/gen_1319.1.gif'"><img src="widgets/gen_1319.1.gif" alt="Directions" name="img104" border="0"></a><br>
                                            <a href="privacypolicy.html" onMouseOver="document.images['img123'].src='widgets/gen_1322.1.gif'" onMouseOut="document.images['img123'].src='widgets/gen_1321.1.gif'"><img src="widgets/gen_1321.1.gif" alt="Privacy Policy" name="img123" border="0"></a><br>
                                            <a href="contactus.html" onMouseOver="document.images['img125'].src='widgets/gen_1324.1.gif'" onMouseOut="document.images['img125'].src='widgets/gen_1323.1.gif'"><img src="widgets/gen_1323.1.gif" alt="Contact Us" name="img125" border="0"></a><br>
                                            <a href="form2.html" onMouseOver="document.images['img346'].src='widgets/gen_4488.1.gif'" onMouseOut="document.images['img346'].src='widgets/gen_4487.1.gif'"><img src="widgets/gen_4487.1.gif" alt="Update E-mail Address" name="img346" border="0"></a><br>
                                            
                                            <a href="mailto:bcosenza@littercorp.com,ahart@littercorp.com" onMouseOver="document.images['img_email'].src='widgets/gen_1331.1.gif'" onMouseOut="document.images['img_email'].src='widgets/gen_4498.1.gif'"><img src="widgets/gen_4498.1.gif" alt="e-mail me" name="img_email" border="0"></a><br>
                                            </td>
                           <td width="13" background="widgets/gen_1290.1.gif"><img src="images/spacer.png" width="13" height="1"></td>
                         </tr>
                         <tr>
                           <td colspan="3"><img src="widgets/gen_1289.1.gif" border=0 width=206 height=17 alt=""></td>
                         </tr>
                      </table>
                      </td></tr>
                      <tr><td><img src="widgets/spacer.gif" height=5 width=20 alt=""></td></tr>
                      <tr>
                      <td WIDTH="206" height="100%">
                      <TABLE WIDTH="206" height="100%" BORDER=0 CELLPADDING=0 CELLSPACING=0 valign="top">
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                             <td width="206" height="12"><img src="widgets/gen_1292.1.gif" border=0 width=206 height=12 alt=""></td>
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                          <tr>
                             <td height="100%" background="widgets/gen_1294.1.gif" height="100%">&nbsp;</td>
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                          <tr>
                             <td width="206" height="12" valign="bottom"><img src="widgets/gen_1293.1.gif" border=0 width=206 height=12 alt=""></td>
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                      </table>
                      </td></tr></table>
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                <td height="100%" width="100%" valign="top">
                       <TABLE DIR="LTR" WIDTH="100%" height="100%" BORDER=0 CELLPADDING=0 CELLSPACING=0 valign="top">
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                             <td width="16" height="15"><img src="widgets/gen_1284.1.gif" border=0 width=16 height=15 alt=""></td>
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                          </tr>
                          <tr>
                             <td height="100%" width="16" background="widgets/gen_1282.1.gif"><img src="widgets/spacer.gif" height=1 width=16 alt=""></td>
                             <TD width="100%" height="100%" bgcolor="#FFFFFF" valign="top"><!-- BOF: ./personal-templates/simple/business/form/html -->
<!-- BOF: ./personal-templates/simple/personal/form/html -->


<center><table border=0>
<tr><td>


<font face='Arial' size='+1' color='#660000'>

Place a Gas Order

</font>


<br>
<SCRIPT LANGUAGE="JavaScript">
var BUILDER = '/servlet/psoft.masonry.Builder';
function validate(frm){
var i = 0;

if (frm.field_195.value=="") return error(frm.field_195);

if (frm.field_197.value=="") return error(frm.field_197);

if (frm.field_329.value=="") return error(frm.field_329);

if (frm.field_198.value=="") return error(frm.field_198);

var url = document.URL;
if (url.indexOf(BUILDER) == -1 && url.charAt(url.length)!='/') {
    url = url.substring(0, url.lastIndexOf('/')+1);
}
frm.domain.value=url;
return true;
}
function error(field){ alert('You did not fill all required fields!'); field.focus(); return false; }
</SCRIPT>
<form name="questionary" action="http://72.51.39.12:8080/servlet/psoft.customform.CustomForm" method="post">
<input type="hidden" name="domain" value="">
<input type="hidden" name="title" value="Place a Gas Order">
<input type="hidden" name="esubj" value="Online Gas Order">
<input type="hidden" name="name" value="=GghoWXsbVRbLl=b">
<input type="hidden" name="submit_url" value="onsubmit.html">
<input type="hidden" name="error_url"  value="onerror.html">
<input type="hidden" name="order" value="195 196 197 329 198 199 200 ">
<table border=0 cellpedding=5 cellspacing=5>

<input type="hidden" name="name_195" value="Name">
<tr><td>


<font face='Arial' size='2' color='#333333'>

Name

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_195" size="">


</td></tr>

<input type="hidden" name="name_196" value="Account #">
<tr><td>


<font face='Arial' size='2' color='#333333'>

Account #

</font>


 </td><td>


<input type="text" name="field_196" size="">


</td></tr>

<input type="hidden" name="name_197" value="Address">
<tr><td>


<font face='Arial' size='2' color='#333333'>

Address

</font>


 <font color="red" size="-1">*</font></td><td>


<textarea name="field_197" rows="" cols=""></textarea>

</td></tr>

<input type="hidden" name="name_329" value="Phone #">
<tr><td>


<font face='Arial' size='2' color='#333333'>

Phone #

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_329" size="">


</td></tr>

<input type="hidden" name="name_198" value="Quantity or Fill">
<tr><td>


<font face='Arial' size='2' color='#333333'>

Quantity or Fill

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_198" size="">


</td></tr>

<input type="hidden" name="name_199" value="Tank %">
<tr><td>


<font face='Arial' size='2' color='#333333'>

Tank %

</font>


 </td><td>


<input type="text" name="field_199" size="">


</td></tr>

<input type="hidden" name="name_200" value="Special Instructions">
<tr><td>


<font face='Arial' size='2' color='#333333'>

Special Instructions

</font>


 </td><td>


<textarea name="field_200" rows="" cols=""></textarea>

</td></tr>

<tr><td colspan=2 align=center>
    <input onClick="return validate(form)" type="submit" value="Submit">
    <input type="reset"  value="Reset">
    </td>
</tr>
</table>
</form>
</td></tr></table></center>
<!-- EOF: ./personal-templates/simple/personal/form/html -->

<!-- EOF: ./personal-templates/simple/business/form/html -->
</td>
                             <td height="100%" width="16" background="widgets/gen_1283.1.gif" align="right"><img src="widgets/spacer.gif" height=1 width=16 alt=""></td>
                          </tr>
                          <tr>
                             <td width="16" height="17"><img src="widgets/gen_1287.1.gif" border=0 width=16 height=17 alt=""></td>
                             <td height="17" width="100%" background="widgets/gen_1280.1.gif"></td>
                             <td width="16" height="17"><img src="widgets/gen_1286.1.gif" border=0 width=16 height=17 alt=""></td>
                          </tr>
                       </table>
                </td>
              </tr>
              <tr>
                 <td width="100%" colspan="2">
                      <TABLE DIR="LTR" WIDTH="100%" BORDER=0 CELLPADDING=0 CELLSPACING=0 valign="top">
                          <tr>
                             <td width="11" height="10"><img src="widgets/gen_1273.1.gif" border=0 width=11 height=10 alt=""></td>
                             <td background="widgets/gen_1275.1.gif" width="100%"></td>
                             <td width="16" height="10"><img src="widgets/gen_1274.1.gif" border=0 width=16 height=10 alt=""></td>
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                          <tr>
                             <td background="widgets/gen_1277.1.gif"><img src="widgets/spacer.gif" height=1 width=1 alt=""></td>
                             <TD bgcolor="#E7804C">
<center><table border="0" cellpadding="0" cellspacing="3"><tr><td align="center">

<br><font face="helvetica,verdana, arial" size="1">&nbsp;</font>

</td></tr></table></center>


<br>
<FONT FACE="verdana, arial, helvetica" SIZE="1">
<center>
<nobr>|<a href="index.html">Intro</A>|</nobr>

<nobr>|<a href="home.html">Home</A>|</nobr>

<nobr>|<a href="history.html">History</A>|</nobr>

<nobr>|<a href="serviceareas.html">Service Areas</A>|</nobr>

<nobr>|<a href="hollandgrills.html">Holland Grills</A>|</nobr>

<nobr>|<a href="newsandevents.html">News & Events</A>|</nobr>

<nobr>|<a href="recipes.html">Recipes</A>|</nobr>

<nobr>|Order Propane|</nobr>

<nobr>|<a href="payment1.html">Make A Payment</A>|</nobr>

<nobr>|<a href="skytracker1.html">SkyTracker</A>|</nobr>

<nobr>|<a href="buffalobuckshtml.html">Referral Program</A>|</nobr>

<nobr>|<a href="insurance1.html">Regulator & Line Insurance</A>|</nobr>

<nobr>|<a href="form.html">Survey</A>|</nobr>

<nobr>|<a href="safetytips.html">Safety Tips</A>|</nobr>

<nobr>|<a href="directions.html">Directions</A>|</nobr>

<nobr>|<a href="privacypolicy.html">Privacy Policy</A>|</nobr>

<nobr>|<a href="contactus.html">Contact Us</A>|</nobr>

<nobr>|<a href="form2.html">Update E-mail Address</A>|</nobr>
</center>
</font>

</td>
                             <td background="widgets/gen_1278.1.gif"><img src="widgets/spacer.gif" height=1 width=1 alt=""></td>
                          </tr>
                          <tr>
                             <td><img src="widgets/gen_1271.1.gif" border=0 width=11 height=15 alt=""></td>
                             <td background="widgets/gen_1276.1.gif" width="100%"></td>
                             <td><img src="widgets/gen_1272.1.gif" border=0 width=16 height=15 alt=""></td>
                          </tr>
                      </table>
                 </td>
              </tr>
            </TABLE>
       </TD>
    </TR>
</TABLE>
<!-- End html -->
                
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<!-- EOF: ./personal-templates/simple/themes.show.body -->

</body>
<!-- BOF: ./personal-templates/simple/themes.show.end -->


<!-- EOF: ./personal-templates/simple/themes.show.end -->


</html>


<!-- EOF: ./personal-templates/show.body -->