<!-- ---------------------------------------------------------------------- -->
<!-- NOTE: Please add the following <META> element to your page <HEAD>. -->
<!-- If necessary, please modify the charset parameter to specify the -->
<!-- character set of your HTML page. -->
<!-- ---------------------------------------------------------------------- -->
<META HTTP-EQUIV="Content-type" CONTENT="text/html; charset=UTF-8">
<script src="https://www.google.com/recaptcha/api.js"></script>
<script>
function timestamp() { var response = document.getElementById("g-recaptcha-response"); if (response == null || response.value.trim() == "") {var elems = JSON.parse(document.getElementsByName("captcha_settings")[0].value);elems["ts"] = JSON.stringify(new Date().getTime());document.getElementsByName("captcha_settings")[0].value = JSON.stringify(elems); } } setInterval(timestamp, 500);
</script>
<!-- ---------------------------------------------------------------------- -->
<!-- NOTE: Please add the following <FORM> element to your page. -->
<!-- ---------------------------------------------------------------------- -->
<form action="https://webto.salesforce.com/servlet/servlet.WebToCase?encoding=UTF-8" method="POST">
<input type=hidden name='captcha_settings' value='{"keyname":"COMP_Support_Form","fallback":"true","orgId":"00D300000000Swd","ts":""}'>
<input type=hidden name="orgid" value="00D300000000Swd">
<input type=hidden name="retURL" value="http://support.companioncorp.com/display/ALEX/Support+Form+Confirmation">
<!-- ---------------------------------------------------------------------- -->
<!-- NOTE: These fields are optional debugging elements. Please uncomment -->
<!-- these lines if you wish to test in debug mode. -->
<!-- <input type="hidden" name="debug" value=1> -->
<!-- <input type="hidden" name="debugEmail" -->
<!-- value="csasithorn@companioncorp.com"> -->
<!-- ---------------------------------------------------------------------- -->
<label for="name"><b>Name *</b></label> <br /><input id="name" maxlength="80" name="name" size="30" type="text" required/><br /><br />
<b>Library Name or Organization *</b> <br /><input id="00N2J00000ApjTM" maxlength="255" name="00N2J00000ApjTM" size="30" type="text" required/><br /><br />
<label for="email"><b>Email</b></label> <br /><input id="email" maxlength="80" name="email" size="30" type="text" /><br /><br />
<label for="phone"><b>Phone</b></label> <br /><input id="phone" maxlength="40" name="phone" size="30" type="text" /><br /><br />
<label for="subject"><b>Subject *</b></label> <br /><input id="subject" maxlength="80" name="subject" size="30" type="text" required/><br /><br />
<label for="description"><b>Description</b></label> <br /><textarea name="description" rows="10" cols="70"></textarea><br /><br />
<b>*</b> indicates a required field
<p></p>
<input type="hidden" id="external" name="external" value="1" /><br>
<div class="g-recaptcha" data-sitekey="6LdR0cMUAAAAAIQLgnX2JqmgtmTq92uTc1rLYAqU"></div><br>
<input type="submit" name="submit">
</form> | 
