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<form
action="http://www.uniquerefinishers.com/cgi-bin/contact.pl"
method="post" name="info" onsubmit="return formValidate()">
<input type="hidden" name="recipient" value="georgia@uniquerefinishers.com"><input
type="hidden" name="subject"
value="Unique Refinishers Contact Information"><input
type="hidden" name="redirect"
value="http://www.uniquerefinishers.com/thanks.html"><table
border="0" cellpadding="0" cellspacing="0" width="100%">
<tr>
<td><font color="#FFFFFF" size="2">
<img
src="images/ct_banner.gif" width="400" height="26"></font><br>
<div align="center"><center><table border="0"
cellpadding="2" cellspacing="0" width="100%">
<tr>
<td valign="top"><font color="#FFFFFF"
size="3"><strong>Unique Refinishers</strong></font><font
color="#FFFFFF" size="2"><br>
<br>
</font><font color="#000000" size="2"><strong><u>Atlanta</u></strong></font><font
color="#FFFFFF" size="2"><br>
5171 Nelson Brogdon Blvd.<br>
Sugar Hill, GA<br>
30518<br>
</font><table border="0" cellpadding="0"
cellspacing="0">
<tr>
<td><font color="#FFFFFF" size="2"><em>Office:
</em></font></td>
<td><font color="#FFFFFF" size="2"><em>(770)
945-0072</em></font></td>
</tr>
<tr>
<td> </td>
<td><font color="#FFFFFF" size="2"><em>(800)
332-0048</em></font></td>
</tr>
<tr>
<td><font color="#FFFFFF" size="2"><em>Fax:</em></font></td>
<td><font color="#FFFFFF" size="2"><em>(770)
271-1514</em></font></td>
</tr>
</table>
<p><font color="#000000" size="2"><strong><u>Detroit</u></strong></font><font
color="#FFFFFF" size="2"><br>
8021 North Haggerty Road<br>
Canton, MI 48187</font></p>
<table border="0" cellpadding="0"
cellspacing="0">
<tr>
<td><font color="#FFFFFF" size="2"><em>Office:</em></font></td>
<td><font color="#FFFFFF" size="2"><em>(734)
459-9900</em></font></td>
</tr>
<tr>
<td><font color="#FFFFFF" size="2"><em>
</em></font></td>
<td><font color="#FFFFFF" size="2"><em>(800)
235-6557</em></font></td>
</tr>
<tr>
<td><font color="#FFFFFF" size="2"><em>Fax:</em></font></td>
<td><font color="#FFFFFF" size="2"><em>(734)
459-9910</em></font></td>
</tr>
</table>
</td>
<td><table border="0" cellpadding="0"
cellspacing="0" width="350">
<tr>
<td align="right" valign="top"><font
color="#FFFFFF" size="2"><strong><br>
<br>
<br>
</strong></font><font color="#000000"
size="2"><strong><br>
Name: </strong></font></td>
<td valign="top"><font
color="#FFFFFF" size="3">If you would
like more information, <br>
please fill out the following form.<br>
<br>
<input type="text" size="20"
name="name"></font></td>
</tr>
<tr>
<td align="right" valign="top"><font
color="#000000" size="2"><strong>Email:</strong></font></td>
<td valign="top"><font
color="#000000" size="3"><input
type="text" size="26" name="email"></font></td>
</tr>
<tr>
<td align="right" valign="top"><font
color="#000000" size="2"><strong>Address:</strong></font></td>
<td valign="top"><font
color="#000000" size="3"><input
type="text" size="26" name="address"></font></td>
</tr>
<tr>
<td align="right" valign="top"><font
color="#000000" size="2"><strong>City:
</strong></font></td>
<td valign="top"><font
color="#000000" size="3"><input
type="text" size="22" name="city"></font></td>
</tr>
<tr>
<td align="right" valign="top"><font
color="#000000" size="2"><strong>State:
</strong></font></td>
<td valign="top"><font
color="#000000" size="3"><input
type="text" size="9" name="state"></font></td>
</tr>
<tr>
<td align="right" valign="top"><font
color="#000000" size="2"><strong>Zip:</strong></font></td>
<td valign="top"><font
color="#000000" size="3"><input
type="text" size="14" name="zip"></font></td>
</tr>
<tr>
<td align="right" valign="top"><font
color="#000000" size="2"><strong>Phone:</strong></font></td>
<td valign="top"><font
color="#FFFFFF" size="3"><input
type="text" size="21" name="phone"></font></td>
</tr>
<tr>
<td valign="top"> </td>
<td valign="top"><font
color="#000000" size="2"><strong><br>
Comments:<br>
</strong></font><textarea
name="comment" rows="7" cols="25"></textarea></td>
</tr>
<tr>
<td> </td>
<td><font color="#FFFFFF" size="3"><br>
<input type="submit" value="Submit"> <input
type="reset" name="reset"
value="Reset"></font></td>
</tr>
</table>
</td>
</tr>
</table>
</center></div></td>
</tr>
</table>
</form>
</body>
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