Following form looked kinda nice. Was used on the Crescent system, though they obviously have their own scripts to run this.

   Name: (required)
  Title: (required) 
Company: 
Address: (required)
Address:
   City: (required)
  State: (required)
    Zip: (required)
Country:
  Phone:
    Fax: 
  email:

Would you like to receive new product information from Crescent via E-mail? Yes No

Do you currently own any Crescent Products? YesNo
If yes, which ones?

 EnQuiry
 Power Pak Pro           Quick Pak Professional
 NetPak Professional     PDQComm
 QuickPak Scientific     XRef 
Other Crescent Products:

Which of the following do you think best describes your primary job function?

How did you first hear about the Jump Start kit?
(required)


Any other comments?