|
Click
here to locate an installer in your area.
We can be contacted by email: info@nuflowtech.com
Or complete the form below and we will contact you be the method you prefer.
Contact Form:
*Required
setAttribute("style","margin: 4px 4px 4px 4px");
$clsHtmlForm->setAttribute("name","submitForm");
$clsHtmlForm->setAttribute("action","contact_us.php");
?>
toOpenTag();
?>
setAttribute("name","command");
$clsHtmlHidden->setAttribute("value","send_contact_us");
echo $clsHtmlHidden->toHtml();
?>
| *First
Name |
setAttribute("name","first_name");
$clsHtmlText->setAttribute("value",$item->getValue("first_name"));
$clsHtmlText->addRequiredFieldValidator("text",
"",
"First Name");
echo $clsHtmlText->toHtml();
?>
|
| *Last
Name |
setAttribute("name","last_name");
$clsHtmlText->setAttribute("value",$item->getValue("last_name"));
$clsHtmlText->addRequiredFieldValidator("text",
"",
"Last Name");
echo $clsHtmlText->toHtml();
?>
|
| *Email Address |
setAttribute("name","email");
$clsHtmlText->setAttribute("value",$item->getValue("email"));
$clsHtmlText->addRequiredFieldValidator("email",
"",
"Email Address");
echo $clsHtmlText->toHtml();
?>
|
| Phone Number |
setAttribute("name","phone_number");
$clsHtmlText->setAttribute("value",$item->getValue("phone_number"));
/*
$clsHtmlText->addRequiredFieldValidator("text",
"",
"Phone Number");
*/
echo $clsHtmlText->toHtml();
?>
|
| Street Address |
setAttribute("name","street_address");
$clsHtmlText->setAttribute("value",$item->getValue("street_address"));
/*
$clsHtmlText->addRequiredFieldValidator("text",
"",
"Street Address");
*/
echo $clsHtmlText->toHtml();
?>
|
| *City |
setAttribute("name","city");
$clsHtmlText->setAttribute("value",$item->getValue("city"));
$clsHtmlText->addRequiredFieldValidator("text",
"",
"City");
echo $clsHtmlText->toHtml();
?>
|
| *State |
setAttribute("name","state");
$clsHtmlText->setAttribute("value",$item->getValue("state"));
$clsHtmlText->addRequiredFieldValidator("text",
"",
"State");
echo $clsHtmlText->toHtml();
?>
|
| *Zip
Code |
setAttribute("name","zip_code");
$clsHtmlText->setAttribute("value",$item->getValue("zip_code"));
$clsHtmlText->addRequiredFieldValidator("text",
"",
"Zip Code");
echo $clsHtmlText->toHtml();
?>
|
| Preferred Method of Contact |
setAttribute("name","preferred_method_of_contact");
$clsHtmlRadio->setAttribute("value","Phone");
if ($item->getValue("preferred_method_of_contact") == "Phone")
{
$clsHtmlRadio->setAttribute("checked","true");
}
$clsHtmlRadio->addRequiredFieldValidator("radio",
"",
"Preferred Method of Contact");
echo $clsHtmlRadio->toHtml();
?>
Phone |
| |
setAttribute("name","preferred_method_of_contact");
$clsHtmlRadio->setAttribute("value","Email");
if ($item->getValue("preferred_method_of_contact") == "Email")
{
$clsHtmlRadio->setAttribute("checked","true");
}
$clsHtmlRadio->addRequiredFieldValidator("radio",
"",
"Preferred Method of Contact");
echo $clsHtmlRadio->toHtml();
?>
Email
|
| Property Type (Check
all that apply) |
setAttribute("name","property_type_0");
$clsHtmlCheckBox->setAttribute("value","Personal Residence");
if ($item->getValue("property_type_0") == "Personal Residence")
{
$clsHtmlCheckBox->setAttribute("checked","true");
}
/*
$clsHtmlCheckBox->addRequiredFieldValidator("checkbox",
"",
"Personal Residence");
*/
echo $clsHtmlCheckBox->toHtml();
?>
Personal Residence
|
| |
setAttribute("name","property_type_1");
$clsHtmlCheckBox->setAttribute("value","Home Owner Assoc.");
if ($item->getValue("property_type_1") == "Home Owner Assoc.")
{
$clsHtmlCheckBox->setAttribute("checked","true");
}
/*
$clsHtmlCheckBox->addRequiredFieldValidator("checkbox",
"",
"Home Owner Assoc.");
*/
echo $clsHtmlCheckBox->toHtml();
?>
Home Owner Assoc.
|
| |
setAttribute("name","property_type_2");
$clsHtmlCheckBox->setAttribute("value","Commercial Building");
if ($item->getValue("property_type_2") == "Commercial Building")
{
$clsHtmlCheckBox->setAttribute("checked","true");
}
/*
$clsHtmlCheckBox->addRequiredFieldValidator("checkbox",
"",
"Commercial Building");
*/
echo $clsHtmlCheckBox->toHtml();
?>
Commercial Building
|
| |
setAttribute("name","property_type_3");
$clsHtmlCheckBox->setAttribute("value","Apartments/Condos");
if ($item->getValue("property_type_3") == "Apartments/Condos")
{
$clsHtmlCheckBox->setAttribute("checked","true");
}
/*
$clsHtmlCheckBox->addRequiredFieldValidator("checkbox",
"",
"Apartments/Condos");
*/
echo $clsHtmlCheckBox->toHtml();
?>
Apartments/Condos
|
| |
setAttribute("name","property_type_4");
$clsHtmlCheckBox->setAttribute("value","Municipal");
if ($item->getValue("property_type_4") == "Municipal")
{
$clsHtmlCheckBox->setAttribute("checked","true");
}
/*
$clsHtmlCheckBox->addRequiredFieldValidator("checkbox",
"",
"Municipal");
*/
echo $clsHtmlCheckBox->toHtml();
?>
Municipal
|
| |
setAttribute("name","property_type_5");
$clsHtmlCheckBox->setAttribute("value","Government/Military");
if ($item->getValue("property_type_5") == "Government/Military")
{
$clsHtmlCheckBox->setAttribute("checked","true");
}
/*
$clsHtmlCheckBox->addRequiredFieldValidator("checkbox",
"",
"Government/Military");
*/
echo $clsHtmlCheckBox->toHtml();
?>
Government/Military
|
| |
setAttribute("name","property_type_6");
$clsHtmlCheckBox->setAttribute("value","School/Church/Etc.");
if ($item->getValue("property_type_6") == "School/Church/Etc.")
{
$clsHtmlCheckBox->setAttribute("checked","true");
}
/*
$clsHtmlCheckBox->addRequiredFieldValidator("checkbox",
"",
"School/Church/Etc.");
*/
echo $clsHtmlCheckBox->toHtml();
?>
School/Church/Etc.
|
| |
setAttribute("name","property_type_7");
$clsHtmlCheckBox->setAttribute("value","Hospital");
if ($item->getValue("property_type_7") == "Hospital")
{
$clsHtmlCheckBox->setAttribute("checked","true");
}
/*
$clsHtmlCheckBox->addRequiredFieldValidator("checkbox",
"",
"Hospital");
*/
echo $clsHtmlCheckBox->toHtml();
?>
Hospital
|
| |
setAttribute("name","property_type_8");
$clsHtmlCheckBox->setAttribute("value","Other");
if ($item->getValue("property_type_8") == "Other")
{
$clsHtmlCheckBox->setAttribute("checked","true");
}
/*
$clsHtmlCheckBox->addRequiredFieldValidator("checkbox",
"",
"Other");
*/
echo $clsHtmlCheckBox->toHtml();
?>
Other
|
| If Other,
Please Explain |
setAttribute("name","property_type_other");
$clsHtmlText->setAttribute("value",$item->getValue("property_type_other"));
/*
$clsHtmlText->addRequiredFieldValidator("text",
"",
"If Other Please Explain");
*/
echo $clsHtmlText->toHtml();
?>
|
| Area of Interest (Check
all that apply) |
setAttribute("name","area_of_interest_0");
$clsHtmlCheckBox->setAttribute("value","Drains/Sewers");
if ($item->getValue("area_of_interest_0") == "Drains/Sewers")
{
$clsHtmlCheckBox->setAttribute("checked","true");
}
/*
$clsHtmlCheckBox->addRequiredFieldValidator("checkbox",
"",
"Area of Interest");
*/
echo $clsHtmlCheckBox->toHtml();
?>
Drains/Sewers |
| |
setAttribute("name","area_of_interest_1");
$clsHtmlCheckBox->setAttribute("value","Hot and Cold Water Lines");
if ($item->getValue("area_of_interest_1") == "Hot and Cold Water Lines")
{
$clsHtmlCheckBox->setAttribute("checked","true");
}
/*
$clsHtmlCheckBox->addRequiredFieldValidator("checkbox",
"",
"Hot and Cold Water Lines");
*/
echo $clsHtmlCheckBox->toHtml();
?>
Hot and Cold Water Lines |
| |
setAttribute("name","area_of_interest_2");
$clsHtmlCheckBox->setAttribute("value","Water Filtration");
if ($item->getValue("area_of_interest_2") == "Water Filtration")
{
$clsHtmlCheckBox->setAttribute("checked","true");
}
/*
$clsHtmlCheckBox->addRequiredFieldValidator("checkbox",
"",
"Water Filtration");
*/
echo $clsHtmlCheckBox->toHtml();
?>
Water Filtration
|
| How Did you First Hear About Us? |
setAttribute("name","how_did_you_first_hear_about_us");
$clsHtmlRadio->setAttribute("value","Television");
if ($item->getValue("how_did_you_first_hear_about_us") == "Television")
{
$clsHtmlRadio->setAttribute("checked","true");
}
$clsHtmlRadio->addRequiredFieldValidator("radio",
"",
"How Did you First Hear About Us?");
echo $clsHtmlRadio->toHtml();
?>
Television |
| |
setAttribute("name","how_did_you_first_hear_about_us");
$clsHtmlRadio->setAttribute("value","Magazine");
if ($item->getValue("how_did_you_first_hear_about_us") == "Magazine")
{
$clsHtmlRadio->setAttribute("checked","true");
}
$clsHtmlRadio->addRequiredFieldValidator("radio",
"",
"How Did you First Hear About Us?");
echo $clsHtmlRadio->toHtml();
?>
Magazine |
| |
setAttribute("name","how_did_you_first_hear_about_us");
$clsHtmlRadio->setAttribute("value","Radio");
if ($item->getValue("how_did_you_first_hear_about_us") == "Radio")
{
$clsHtmlRadio->setAttribute("checked","true");
}
$clsHtmlRadio->addRequiredFieldValidator("radio",
"",
"How Did you First Hear About Us?");
echo $clsHtmlRadio->toHtml();
?>
Radio |
| |
setAttribute("name","how_did_you_first_hear_about_us");
$clsHtmlRadio->setAttribute("value","Referral");
if ($item->getValue("how_did_you_first_hear_about_us") == "Referral")
{
$clsHtmlRadio->setAttribute("checked","true");
}
$clsHtmlRadio->addRequiredFieldValidator("radio",
"",
"How Did you First Hear About Us?");
echo $clsHtmlRadio->toHtml();
?>
Referral |
| |
setAttribute("name","how_did_you_first_hear_about_us");
$clsHtmlRadio->setAttribute("value","Friend");
if ($item->getValue("how_did_you_first_hear_about_us") == "Friend")
{
$clsHtmlRadio->setAttribute("checked","true");
}
$clsHtmlRadio->addRequiredFieldValidator("radio",
"",
"How Did you First Hear About Us?");
echo $clsHtmlRadio->toHtml();
?>
Friend |
| |
setAttribute("name","how_did_you_first_hear_about_us");
$clsHtmlRadio->setAttribute("value","Search Engine");
if ($item->getValue("how_did_you_first_hear_about_us") == "Search Engine")
{
$clsHtmlRadio->setAttribute("checked","true");
}
$clsHtmlRadio->addRequiredFieldValidator("radio",
"",
"How Did you First Hear About Us?");
echo $clsHtmlRadio->toHtml();
?>
Search Engine |
| |
setAttribute("name","how_did_you_first_hear_about_us");
$clsHtmlRadio->setAttribute("value","Tradeshow");
if ($item->getValue("how_did_you_first_hear_about_us") == "Tradeshow")
{
$clsHtmlRadio->setAttribute("checked","true");
}
$clsHtmlRadio->addRequiredFieldValidator("radio",
"",
"How Did you First Hear About Us?");
echo $clsHtmlRadio->toHtml();
?>
Tradeshow |
| |
setAttribute("name","how_did_you_first_hear_about_us");
$clsHtmlRadio->setAttribute("value","Other");
if ($item->getValue("how_did_you_first_hear_about_us") == "Other")
{
$clsHtmlRadio->setAttribute("checked","true");
}
$clsHtmlRadio->addRequiredFieldValidator("radio",
"",
"How Did you First Hear About Us?");
echo $clsHtmlRadio->toHtml();
?>
Other |
| If Other, Please Explain |
setAttribute("name","if_other_please_explain");
$clsHtmlText->setAttribute("value",$item->getValue("if_other_please_explain"));
/*
$clsHtmlText->addRequiredFieldValidator("text",
"",
"If Other, Please Explain");
*/
echo $clsHtmlText->toHtml();
?>
|
| |
setAttribute("name","button_go");
$clsHtmlButton->setAttribute("value","Submit");
$clsHtmlButton->setAttribute("onclick","return Form_OnContactUsSubmit('" . $clsHtmlForm->getAttribute("name") . "');");
echo $clsHtmlButton->toHtml();
?>
|
| |
We respect your
privacy. We will not sell, trade or give away your contact information. |
toCloseTag();
?>
|