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table width="100%">
<tr>
<td width="28%"><font face="Tahoma" size="2"><b>Pick up or Deliver
to? </b></font></td>
<td width="72%"> <font face="Tahoma" size="2">
<select name="s" size="1">
<option selected>Pick-Up from</option>
<option>Deliver to</option>
</select>
<font color="#FF3333"></font></font></td>
</tr>
<tr>
<td width="28%"><font face="Tahoma" size="2"><b>Account Holder:</b></font></td>
<td width="72%"> <font face="Tahoma" size="2">
<input type="text" name="C" size="30">
<b>(company name only)</b></font></td>
</tr>
<tr>
<td width="28%"><font face="Tahoma" size="2"><b>Pick up or Deliver
to?</b></font></td>
<td width="72%"> <font face="Tahoma" size="2">
<select name="s2" size="1">
<option>Pick-Up from</option>
<option selected>Deliver to</option>
</select>
</font></td>
</tr>
<tr>
<td width="28%"><font face="Tahoma" size="2"><b>Street Address including
Suite Number:</b></font></td>
<td width="72%"> <font face="Tahoma" size="2">
<input type="text" name="sa" size="30">
<b>(ex: #202-333 5th St.)</b></font></td>
</tr>
<tr>
<td width="28%"><font face="Tahoma" size="2"><b>City:</b></font></td>
<td width="72%"> <font face="Tahoma" size="2">
<input type="text" name="ct" size="30">
</font></td>
</tr>
<tr>
<td width="28%"><font size="2" face="Tahoma"><b>Service Required:</b></font></td>
<td width="72%"> <font face="Tahoma" size="2">
<select name="srv">
<option value="MBCIBTBDB" selected>must be called in by 11 a.m. to be delivered by 5p.m.</option>
<option value="2hr">2 hour</option>
<option value="SD">Same Day</option>
<option value="REG">Regular 4 hour</option>
<option value="1hr">RUSH 1 hour</option>
</select>
<a href="#" onclick="javascript: window.open('index2.html', 'window_name',
'height=640,width=320');">What are the cut-off times?</a></font></td>
</tr>
<tr bgcolor="#180CA0">
<td height="15" colspan="2">&nbsp;</td>
</tr>
<tr>
<td width="100%" height="15" colspan="2">
<p align="left"><font size="2" face="Tahoma"><b><font color="#E02420">Before
you click submit, please confirm:</font></b></font></p>
<ul>
<li><font size="2" face="Tahoma">You are a current TDEx Delivery Service
Account Holder </font></li>
<li><font size="2" face="Tahoma">Your order is less than 25 lbs.</font></li>
<li><font size="2" face="Tahoma">Your order ready for immediate
pick-up.</font></li>
</ul>
<p><font face="Tahoma" size="2"><b><font color="#E02420">If not,
please call 602 212 9492</font></b></font></p>
<p><font face="Tahoma" size="2"><b>*Press submit only once.</b></font></p>
</td>
</tr>
<tr>
<td width="100%" height="15" colspan="2">
<div align="center">
<input type="submit" name="Submit" value="Submit Order">
<input type="reset" name="Submit2" value="Reset">
</div>
</td>
</tr>
<tr bgcolor="#180CA0">
<td width="100%" height="15" colspan="2">&nbsp;</td>
</tr>
</table>
</form>

</td>
</tr>
<tr>
<td colspan="2">
<div align="center"><font face="Tahoma" size="2" color="#6058A8"><b></b></font></div>
</td>
</tr>
</table>
<div align="left"></div>
</body>
</html>