<META HTTP-EQUIV="Content-type" CONTENT="text/html; charset=UTF-8"/>
<form action="https://webto.salesforce.com/servlet/servlet.WebToCase?encoding=UTF-8" method="POST">
<input type="hidden" name="orgid" value="00D300000000Swd"/>
<input type="hidden" name="retURL" value="http://support.companioncorp.com"/>
<input type="hidden" name="debug" value="1" />
<input type="hidden" name="debugEmail" value="mvoseipka@companioncorp.com"/>
<label for="name"><b>Name</b></label> <br /><input id="name" maxlength="80" name="name" size="30" type="text" /><br /><br />
<label for="email">Email<><b>Email</b></label> <br /><input id="email" maxlength="80" name="email" size="30" type="text" /><br /><br />
<label for="phone">Phone<><b>Phone</b></label> <br /><input id="phone" maxlength="40" name="phone" size="30" type="text" /><br /><br />
<label for="subject">Subject<><b>Subject</b></label> <br /><input id="subject" maxlength="80" name="subject" size="30" type="text" /><br /><br />
<label for="description">Description<><b>Description</b></label> <br /><textarea name="description" rows="10" cols="70"></textarea><br /><br />
<input type="submit" name="submit"/>
</form> |