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			<div id="breadcrumbs"><a href="index">home</a> : request demo</div>
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			<!-- begin: main content -->
			<div id="insideContent">
				<div id="loginContent">
					<form id="loginform" action="/pub/cgi-bin/FormMail.pl" method="post" onsubmit="return validateForm(this);">
						<fieldset class="trialSignup">
							<legend>Request PortBlue Demo</legend>
								<br/>
								<p class="top">Thank you for your interest in PortBlue Corporation. Please fill in the following information, and we will be in contact to arrange a demo.</p>

								<div class="content">
								<label for="firstField">First Name:</label>
								<input id="firstField" name="firstname" type="text" maxlength="80" value=""/><br class="clear"/>

								<label for="lastField">Last Name:</label>
								<input id="lastField" name="lastname" type="text" maxlength="80" value=""/><br class="clear"/>

								<label for="titleField">Title:</label>
								<input id="titleField" name="persontitle" type="text" maxlength="80" value=""/><br class="clear"/>

								<label for="companyField">Company:</label>
								<input id="companyField" name="company" type="text" maxlength="80" value=""/><br class="clear"/>

								<label for="phoneField">Phone:</label>
								<input class="med" id="phoneField" name="phonenumber" type="text" maxlength="40" value=""/><br class="clear"/>

								<label for="emailField">Email:</label>
								<input id="emailField" name="email" type="text" maxlength="80" value=""/><br class="clear"/>

								<label for="areaField">Area/Solution of Interest:</label>
								<textarea id="areaField" cols="40" rows="5" name="information"></textarea><br class="clear"/>

								<label>&nbsp;</label>
                                                <input type="hidden" name="recipient" value="support@portblue.com"/>
                                                <input type="hidden" name="subject" value="Information Request"/>
                                                <input type="hidden" name="realname" value="PB Public Pages"/>
                                               <!-- <input type="hidden" name="redirect" value="../index"/> -->
                                                <input type="hidden" name="redirect" value="../request-demo-confirm.shtml"/>
                                                <input type="hidden" name="env_report" value="REMOTE_HOST,REMOTE_ADDR,REMOTE_USER,HTTP_USER_AGENT,HTTP_REFERER"/>
                                                <input type="hidden" name="print_config" value="firstname,lastname,persontitle,company,phonenumber,email,information"/>
								<input class="submit" type="submit" value="Send Request"/><br class="clear"/>
								</div>

								<p class="bottom">We will reply to your inquiry as quickly as possible, and we appreciate your interest.</p>
							</fieldset>
						</form>
				</div>
			</div>
			<!-- end: main content -->

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			<!-- begin: menubar -->
			<div id="menubarInside">
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			</div>
			<!-- end: menubar -->

		</div>
	</body>

</html>