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<HTML>

<HEAD>


<META NAME="description" CONTENT="Monarch Textile Rental Services Quality Linen Service since 1956.">
<META NAME="Keywords"    CONTENT="monarch, textile, rentals, linens, entrance mats, safety mats, logo mats, towels, patient gowns, labcoats, pillowcases, rags, business wear, embroidered, executive shirts, executive pants, jackets, jeans, industrial pants, industrial shirts, aprons, chef uniforms, cook uniforms, table linen, napkins, paper products, air fresheners, soap dispensers, dust mops, wet mops, washcloths, sheets, lint free, dust control, uniform rentals,linen supply, linen suppliers, uniform suppliers, table linens,">


<!-- business -->


<META HTTP-EQUIV="Content-Type" CONTENT="text/html; charset=UTF-8">
<META NAME="Generator" content="">
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<!--<BASE HREF="http://monarch.supremeserver24.com/form.html">-->
<TITLE>Orders/Add-Ons</TITLE></head>
<BODY  BGCOLOR="#C1E2FD"
 TEXT="#0C2B56"

LEFTMARGIN="0" TOPMARGIN="0" RIGHTMARGIN="0" BOTTOMMARGIN="0"

 onLoad=""
 
 LINK="#FFFFFF"
 VLINK="#4187DE"
 ALINK="#0457BE"
>

  
      <!-- BOF: ./personal-templates/simple/businessnew/layout/l47.layout --> 


<!-- html -->

<TABLE WIDTH="100%" HEIGHT="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
  <TR>
    <TD HEIGHT="100%">
      <TABLE HEIGHT="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
        <TR>
          <TD HEIGHT="100%">
             <TABLE WIDTH=322 HEIGHT="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
             <TR>
               <TD WIDTH=322 HEIGHT=216>
                  <IMG SRC="widgets/gen_21.1.gif" WIDTH=322 HEIGHT=216 ALT="" BORDER="0"></TD>
              </TR>
              <TR>
                <TD HEIGHT="100%">
                    <TABLE WIDTH=322 HEIGHT="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
                       <TR>
                          <TD HEIGHT="100%" WIDTH=37 BACKGROUND="widgets/gen_31.1.gif" VALIGN="bottom"><IMG SRC="widgets/gen_29.1.gif" WIDTH=37 HEIGHT=105 ALT=""></TD>
                          <TD HEIGHT="100%" WIDTH=160 VALIGN="top" BACKGROUND="widgets/gen_28.1.gif">
               <a href="index.html" onMouseOver="document.images['img6'].src='widgets/gen_86.1.gif'" onMouseOut="document.images['img6'].src='widgets/gen_85.1.gif'"><img src="widgets/gen_85.1.gif" alt="The Monarch Difference" name="img6" border="0"></a><br>
               <a href="customerservice.html" onMouseOver="document.images['img7'].src='widgets/gen_141.1.gif'" onMouseOut="document.images['img7'].src='widgets/gen_140.1.gif'"><img src="widgets/gen_140.1.gif" alt="Customer Service" name="img7" border="0"></a><br>
               <a href="form.html" onMouseOver="document.images['img36'].src='widgets/gen_376.1.gif'" onMouseOut="document.images['img36'].src='widgets/gen_375.1.gif'"><img src="widgets/gen_375.1.gif" alt="Orders/Add-Ons" name="img36" border="0"></a><br>
               <a href="about.html1.html" onMouseOver="document.images['img22'].src='widgets/gen_237.1.gif'" onMouseOut="document.images['img22'].src='widgets/gen_236.1.gif'"><img src="widgets/gen_236.1.gif" alt="Towels and Aprons" name="img22" border="0"></a><br>
               <a href="about.html4.html" onMouseOver="document.images['img30'].src='widgets/gen_293.1.gif'" onMouseOut="document.images['img30'].src='widgets/gen_292.1.gif'"><img src="widgets/gen_292.1.gif" alt="Restroom Services" name="img30" border="0"></a><br>
               <a href="about.html2.html" onMouseOver="document.images['img28'].src='widgets/gen_245.1.gif'" onMouseOut="document.images['img28'].src='widgets/gen_244.1.gif'"><img src="widgets/gen_244.1.gif" alt="Dust Control Mats" name="img28" border="0"></a><br>
               <a href="about.html3.html" onMouseOver="document.images['img29'].src='widgets/gen_291.1.gif'" onMouseOut="document.images['img29'].src='widgets/gen_290.1.gif'"><img src="widgets/gen_290.1.gif" alt="Uniform Services" name="img29" border="0"></a><br>
               <a href="gpage.html" onMouseOver="document.images['img26'].src='widgets/gen_241.1.gif'" onMouseOut="document.images['img26'].src='widgets/gen_240.1.gif'"><img src="widgets/gen_240.1.gif" alt="Healthcare Linen" name="img26" border="0"></a><br>
               <a href="services.html" onMouseOver="document.images['img18'].src='widgets/gen_202.1.gif'" onMouseOut="document.images['img18'].src='widgets/gen_201.1.gif'"><img src="widgets/gen_201.1.gif" alt="Linen Services" name="img18" border="0"></a><br>
               <a href="about.html5.html" onMouseOver="document.images['img31'].src='widgets/gen_319.1.gif'" onMouseOut="document.images['img31'].src='widgets/gen_318.1.gif'"><img src="widgets/gen_318.1.gif" alt="Mop Services" name="img31" border="0"></a><br>
               <a href="job.html" onMouseOver="document.images['img32'].src='widgets/gen_321.1.gif'" onMouseOut="document.images['img32'].src='widgets/gen_320.1.gif'"><img src="widgets/gen_320.1.gif" alt="Careers" name="img32" border="0"></a><br>
               
               <a href="mailto:rburt@monarchlinen.com" onMouseOver="document.images['img_email'].src='widgets/gen_35.1.gif'" onMouseOut="document.images['img_email'].src='widgets/gen_34.1.gif'"><img src="widgets/gen_34.1.gif" alt="e-mail me" name="img_email" border="0"></a><br></TD>
                          <TD HEIGHT="100%" WIDTH=125><IMG SRC="widgets/spacer.gif" WIDTH=1 HEIGHT=1></TD>
                       </TR>
                       <TR>
                          <TD WIDTH=37 HEIGHT=34 VALIGN="bottom">
                                 <IMG SRC="widgets/gen_30.1.gif" WIDTH=37 HEIGHT=34 ALT=""></TD>
                          <TD WIDTH=160 HEIGHT=34 VALIGN="bottom">
                                 <IMG SRC="widgets/gen_22.1.gif" WIDTH=160 HEIGHT=34 ALT=""></TD>
                          <TD WIDTH=125 HEIGHT=34 VALIGN="bottom">
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                       </TR>
                    </TABLE>
                </TD>
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             </TABLE>
          </TD>
          <TD WIDTH="100%">
             <TABLE WIDTH="100%" HEIGHT=100% BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
                    <TR>
                      <TD WIDTH="100%" HEIGHT=70 VALIGN="top">
             <TABLE WIDTH="100%" HEIGHT=70 BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
               <TR>
                 <TD WIDTH=100% HEIGHT=42 ALIGN="right" BACKGROUND="widgets/gen_20.1.gif"></TD>
                 <TD WIDTH=352 HEIGHT=42 ALIGN="right"><IMG SRC="widgets/gen_84.1.gif" WIDTH=352 HEIGHT=42 ALT="" BORDER="0"></TD>
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               <TR>
                 <TD WIDTH=100% HEIGHT=28 ALIGN="right"></TD>
                 <TD WIDTH=352 HEIGHT=28><IMG SRC="widgets/gen_25.1.gif" WIDTH=352 HEIGHT=28 ALT="" BORDER="0"></TD>
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           </TABLE>
             </TD>
             </TR>
             <TR>
             <TD WIDTH="100%" HEIGHT="100%" VALIGN="top">
           <TABLE WIDTH="100%" HEIGHT="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
              <TR>
                <TD WIDTH="100%" HEIGHT="100%" VALIGN="top"><IMG SRC="widgets/spacer.gif" WIDTH=1 HEIGHT=1>
                   <!-- BOF: ./personal-templates/simple/businessnew/form/style_l47.html -->


<TABLE  WIDTH=100% BORDER=0 CELLPADDING=0 CELLSPACING=0 VALIGN="top">
                                                        <TR>
                                                                <TD WIDTH=369 HEIGHT=57><IMG SRC="widgets/gen_374.1.gif" WIDTH=369 HEIGHT=57></TD>
                                                                 <TD WIDTH=100% HEIGHT=57 ALIGN="left"><IMG SRC="widgets/gen_10.1.gif" WIDTH=30 HEIGHT=57></TD>

                                                        </TR>        
                                                </TABLE>

<TABLE WIDTH=100% BORDER=0 CELLPADDING=0 CELLSPACING=0 VALIGN="top">
        <TR>
                <TD COLSPAN="2"></TD>
                                        
        </TR>
        <TR>
                <TD WIDTH=100% COLSPAN="2" VALIGN="top">
                        <TABLE WIDTH=90% BORDER=0 CELLPADDING=5 CELLSPACING=0 VALIGN="top">
                        <TR>
                                

<SCRIPT LANGUAGE="JavaScript">
function validate(){
        var valid;
        valid=true;
        var valueExists;


if (document.forms[0].field_40.value==""){ valid=false; };


if (document.forms[0].field_45.value==""){ valid=false; };


if (document.forms[0].field_50.value==""){ valid=false; };


if (document.forms[0].field_41.value==""){ valid=false; };


if (document.forms[0].field_46.value==""){ valid=false; };


if (document.forms[0].field_y_44.value==""){ valid=false; };


if (document.forms[0].field_y_42.value==""){ valid=false; };


if (document.forms[0].field_49.value==""){ valid=false; };


if (document.forms[0].field_51.value==""){ valid=false; };


if (valid==false) { 
                alert('You did not fill all required fields!'); 
            }

return valid;
}
</SCRIPT>

<form name="questionary" action="http://supremecenter24.com:8080/servlet/psoft.customform.CustomForm" method="post">
<input type="hidden" name="form_id" value="36">
<input type="hidden" name="user_id" value="2085">
<input type="hidden" name="title" value="Orders/Add-Ons">

<input type="hidden" name="name" value="email1.html">


<input type="hidden" name="order" value="40 45 50 41 46 d44 d42 49 51 48 ">
<input type="hidden" name="submit_url" value="http://monarch.supremeserver24.com/onsubmit1.html">
<input type="hidden" name="error_url" value="http://monarch.supremeserver24.com/onerror1.html">
                                <TD VALIGN="top">
                                        <TABLE VALIGN="top" border="0" cellpadding="5" cellspacing="5" width="95%">
                                                <TR>
                                                        <TD colspan=2>&nbsp;</td>
                                                </TR>


<input type="hidden" name="name_40" value="Company name:">
                                                <TR>    
                                                        <TD VALIGN="top">


<font face='Arial' size='2' color='#0C2B56'>

Company name:

</font>


<font color="red" size="-1">*</font></td>
                                                        <TD>
                                                                
                                                                
                                                                <input type="text" name="field_40" size="35">
                                                                
                                                                
                                                         </TD>
                                                </TR> 

<input type="hidden" name="name_45" value="First Name:">
                                                <TR>    
                                                        <TD VALIGN="top">


<font face='Arial' size='2' color='#0C2B56'>

First Name:

</font>


<font color="red" size="-1">*</font></td>
                                                        <TD>
                                                                
                                                                
                                                                <input type="text" name="field_45" size="35">
                                                                
                                                                
                                                         </TD>
                                                </TR> 

<input type="hidden" name="name_50" value="Last Name:">
                                                <TR>    
                                                        <TD VALIGN="top">


<font face='Arial' size='2' color='#0C2B56'>

Last Name:

</font>


<font color="red" size="-1">*</font></td>
                                                        <TD>
                                                                
                                                                
                                                                <input type="text" name="field_50" size="35">
                                                                
                                                                
                                                         </TD>
                                                </TR> 

<input type="hidden" name="name_41" value="Account Number :(Must be 7 numbers)">
                                                <TR>    
                                                        <TD VALIGN="top">


<font face='Arial' size='2' color='#0C2B56'>

Account Number :(Must be 7 numbers)

</font>


<font color="red" size="-1">*</font></td>
                                                        <TD>
                                                                
                                                                
                                                                <input type="text" name="field_41" size="35">
                                                                
                                                                
                                                         </TD>
                                                </TR> 

<input type="hidden" name="name_46" value="Phone number that you are calling from:">
                                                <TR>    
                                                        <TD VALIGN="top">


<font face='Arial' size='2' color='#0C2B56'>

Phone number that you are calling from:

</font>


<font color="red" size="-1">*</font></td>
                                                        <TD>
                                                                
                                                                
                                                                <input type="text" name="field_46" size="35">
                                                                
                                                                
                                                         </TD>
                                                </TR> 

<input type="hidden" name="name_44" value="When is your next delivery date?">
                                                <TR>    
                                                        <TD VALIGN="top">


<font face='Arial' size='2' color='#0C2B56'>

When is your next delivery date?

</font>


<font color="red" size="-1">*</font></td>
                                                        <TD>
                                                                
                                                                
                                                                <select name="field_m_44" size="1">
                                                                <option>Jan
                                                                <option>Feb
                                                                <option>Mar
                                                                <option>Apr
                                                                <option>May
                                                                <option>Jun
                                                                <option>Jul
                                                                <option>Aug
                                                                <option>Sep
                                                                <option>Oct
                                                                <option>Nov
                                                                <option>Dec
                                                                </select>
                                                                <select name="field_d_44" size="1">
                                                                <option>1<option>2<option>3<option>4<option>5<option>6<option>7<option>8<option>9<option>10<option>11<option>12<option>13<option>14<option>15<option>16<option>17<option>18<option>19<option>20<option>21<option>22<option>23<option>24<option>25<option>26<option>27<option>28<option>29<option>30<option>31
                                                                </select>
                                                                <input type="text" name="field_y_44" size="4" maxsize="4">
                                                                
                                                         </TD>
                                                </TR> 

<input type="hidden" name="name_42" value="When are your items required?">
                                                <TR>    
                                                        <TD VALIGN="top">


<font face='Arial' size='2' color='#0C2B56'>

When are your items required?

</font>


<font color="red" size="-1">*</font></td>
                                                        <TD>
                                                                
                                                                
                                                                <select name="field_m_42" size="1">
                                                                <option>Jan
                                                                <option>Feb
                                                                <option>Mar
                                                                <option>Apr
                                                                <option>May
                                                                <option>Jun
                                                                <option>Jul
                                                                <option>Aug
                                                                <option>Sep
                                                                <option>Oct
                                                                <option>Nov
                                                                <option>Dec
                                                                </select>
                                                                <select name="field_d_42" size="1">
                                                                <option>1<option>2<option>3<option>4<option>5<option>6<option>7<option>8<option>9<option>10<option>11<option>12<option>13<option>14<option>15<option>16<option>17<option>18<option>19<option>20<option>21<option>22<option>23<option>24<option>25<option>26<option>27<option>28<option>29<option>30<option>31
                                                                </select>
                                                                <input type="text" name="field_y_42" size="4" maxsize="4">
                                                                
                                                         </TD>
                                                </TR> 

<input type="hidden" name="name_49" value="Please specify Quantity   *   Color   *    Item">
                                                <TR>    
                                                        <TD VALIGN="top">


<font face='Arial' size='2' color='#0C2B56'>

Please specify Quantity   *   Color   *    Item

</font>


<font color="red" size="-1">*</font></td>
                                                        <TD>
                                                                
                                                                
                                                                <textarea name="field_49" rows="5" cols="30"></textarea>
                                                                
                                                                
                                                         </TD>
                                                </TR> 

<input type="hidden" name="name_51" value="E-Mail Address: (so that we may confirm your order/add-on)">
                                                <TR>    
                                                        <TD VALIGN="top">


<font face='Arial' size='2' color='#0C2B56'>

E-Mail Address: (so that we may confirm your order/add-on)

</font>


<font color="red" size="-1">*</font></td>
                                                        <TD>
                                                                
                                                                
                                                                <textarea name="field_51" rows="5" cols="30"></textarea>
                                                                
                                                                
                                                         </TD>
                                                </TR> 

<input type="hidden" name="name_48" value="Any Special Instructions?">
                                                <TR>    
                                                        <TD VALIGN="top">


<font face='Arial' size='2' color='#0C2B56'>

Any Special Instructions?

</font>


</td>
                                                        <TD>
                                                                
                                                                
                                                                <textarea name="field_48" rows="5" cols="30"></textarea>
                                                                
                                                                
                                                         </TD>
                                                </TR> 

                                                <TR>
                                                        <TD COLSPAN="2">
                                                         
                                                                <input type="submit" onClick="return validate()"><input type="reset">
                                                        </TD>
                                                </TR>
                                        </TABLE>
                                </TD>
                        </TR>
</form> 
                </TABLE>
        </TD>
</TR>
</TABLE>


<!-- EOF: ./personal-templates/simple/businessnew/form/style_l40.html -->

                                                </TD>
                <TD HEIGHT="100%" WIDTH="24" BACKGROUND="widgets/gen_18.1.gif"><IMG SRC="widgets/spacer.gif" WIDTH=24 HEIGHT=10></TD>
              </TR>
           </TABLE>
           </TD>
           </TR>
           </TABLE>
          </TD>
        </TR>
      </TABLE>
    </TD>
  </TR>
  <TR>
    <TD VALIGN="top">
       <TABLE WIDTH="100%" HEIGHT=100% BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top">
          <TR>
             <TD WIDTH=18 HEIGHT=20 VALIGN="top"><IMG SRC="widgets/gen_11.1.gif" WIDTH=18 HEIGHT=20 ALT=""></TD>
             <TD WIDTH=100% HEIGHT=20 VALIGN="top" BACKGROUND="widgets/gen_27.1.gif">&nbsp;</TD>
             <TD WIDTH=24 HEIGHT=20 ALIGN="right" VALIGN="top"><IMG SRC="widgets/gen_12.1.gif" WIDTH=24 HEIGHT=20 ALT=""></TD>
          </TR>
          <TR>
             <TD HEIGHT=100% WIDTH=18 BACKGROUND="widgets/gen_14.1.gif">&nbsp;</TD>
             <TD WIDTH=100% BGCOLOR="#71BDFD">

<br>
<FONT FACE="verdana, arial, helvetica" SIZE="1">
<center>
<nobr>|<a href="index.html">The Monarch Difference</A>|</nobr>

<nobr>|<a href="customerservice.html">Customer Service</A>|</nobr>

<nobr>|Orders/Add-Ons|</nobr>

<nobr>|<a href="about.html1.html">Towels and Aprons</A>|</nobr>

<nobr>|<a href="about.html4.html">Restroom Services</A>|</nobr>

<nobr>|<a href="about.html2.html">Dust Control Mats</A>|</nobr>

<nobr>|<a href="about.html3.html">Uniform Services</A>|</nobr>

<nobr>|<a href="gpage.html">Healthcare Linen</A>|</nobr>

<nobr>|<a href="services.html">Linen Services</A>|</nobr>

<nobr>|<a href="about.html5.html">Mop Services</A>|</nobr>

<nobr>|<a href="job.html">Careers</A>|</nobr>
</center>
</font>

<br>
<center><table border="0" cellpadding="0" cellspacing="3"><tr><td align="center">

<br><font face="helvetica,verdana, arial" size="1">&nbsp;</font>

</td></tr></table></center>
</TD>
             <TD HEIGHT=100% WIDTH=24 BACKGROUND="widgets/gen_13.1.gif"></TD>
          </TR>
          <TR>
             <TD WIDTH=18 HEIGHT=22 VALIGN="bottom"><IMG SRC="widgets/gen_15.1.gif" WIDTH=18 HEIGHT=22 ALT=""></TD>
             <TD BACKGROUND="widgets/gen_17.1.gif">&nbsp;</TD>
             <TD WIDTH=24 HEIGHT=22><IMG SRC="widgets/gen_16.1.gif" WIDTH=24 HEIGHT=22 ALT=""></TD>
         </TR>
       </TABLE>      
    </TD>
  </TR> 
</TABLE> 
<!-- end html -->
                
<!-- EOF: ./personal-templates/simple/business/layout/l47.layout -->

    
<!-- BOF: ./personal-templates/simple/themes.show.body -->


<!-- EOF: ./personal-templates/simple/themes.show.body -->

</body>
<!-- BOF: ./personal-templates/simple/themes.show.end -->


<!-- EOF: ./personal-templates/simple/themes.show.end -->


</html>


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