<!-- BOF: ./personal-templates/show.body -->
<!-- BOF: ./personal-templates/simple/generic/show -->
<!-- BOF: ./personal-templates/rtl.html -->
<!-- Locale=en_US -->
<!-- EOF: ./personal-templates/rtl.html -->


<!-- BOF: ./personal-templates/simple/generic/functions -->
<!-- BOF: ./personal-templates/simple/generic/navbar --><!-- EOF: ./personal-templates/simple/generic/navbar -->


<!-- EOF: ./personal-templates/simple/generic/functions -->


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

<!-- BOF: ./personal-templates/simple/generic/images -->

<!-- EOF: ./personal-templates/simple/generic/images -->


<!-- BOF: ./personal-templates/simple/personal/other/l85.settings.init -->


<!-- EOF: ./personal-templates/simple/personal/other/l85.settings.init -->


  <!-- BOF: ./personal-templates/simple/business/layout/l88.wait -->


<!-- EOF: ./personal-templates/simple/business/layout/l88.wait -->


<HTML>

<HEAD>


<META NAME="description" CONTENT="Auto Glass, Windshields, Door Glass, Quarter Glass, Back Glass, Windshield Repair, Windscreen, Auto Glass Network Partner">
<META NAME="Keywords"    CONTENT="Auto Glass,Windshields,Door Glass,Quarter Glass,Back Glass,Windshield Repair,Windscreen,California,Hemet,Temecula,Sun City,San Jacinto,Glass,Automotive,">


<!-- business -->


<META HTTP-EQUIV="Content-Type" CONTENT="text/html; charset=UTF-8">
<META NAME="Generator" content="">
<!-- BOF: ./personal-templates/simple/themes.show -->


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


<!--<BASE HREF="http://www.shelbyautoglass.com/form.html">-->
<TITLE>Quote Form</TITLE></head>
<BODY  BGCOLOR="#FFFFFF"
 TEXT="#000000"

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

 onLoad=""
 
 LINK="#878689"
 VLINK="#2F176B"
 ALINK="#524476"
>

  
      <!-- BOF: ./personal-templates/simple/business/layout/l88.layout --> 

<!-- html -->
<TABLE WIDTH="100%" HEIGHT="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top" >
    <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%" VALIGN="top">
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                            <TR>
                                <TD WIDTH="10%" VALIGN="top"><img src="widgets/spacer.gif" height=5 width=5 alt=""></TD>       
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                                            <TD COLSPAN="2" WIDTH="174" HEIGHT="25" VALIGN="top" BGCOLOR="#FFFFFF"><img src="widgets/gen_781.1.gif" border=0 width=174 height=25 alt=""></TD>
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                                        <TR>
                                            <TD WIDTH="174" HEIGHT="100%" VALIGN="top" BGCOLOR="#243FAD" BACKGROUND="widgets/gen_782.1.gif" style="background-repeat: no-repeat;">
                                                
                                                <a href="index.html" onMouseOver="document.images['img7'].src='widgets/gen_794.1.gif'" onMouseOut="document.images['img7'].src='widgets/gen_793.1.gif'"><img src="widgets/gen_793.1.gif" alt="Home" name="img7" border="0"></a><br>
                                                
                                                
                                                <a href="locations.html" onMouseOver="document.images['img9'].src='widgets/gen_796.1.gif'" onMouseOut="document.images['img9'].src='widgets/gen_795.1.gif'"><img src="widgets/gen_795.1.gif" alt="Locations" name="img9" border="0"></a><br>
                                                
                                                
                                                <a href="dealersbodyshop.html" onMouseOver="document.images['img71'].src='widgets/gen_961.1.gif'" onMouseOut="document.images['img71'].src='widgets/gen_960.1.gif'"><img src="widgets/gen_960.1.gif" alt="Dealers / B.Shop" name="img71" border="0"></a><br>
                                                
                                                
                                                <a href="fleet.html" onMouseOver="document.images['img36'].src='widgets/gen_800.1.gif'" onMouseOut="document.images['img36'].src='widgets/gen_799.1.gif'"><img src="widgets/gen_799.1.gif" alt="Fleet" name="img36" border="0"></a><br>
                                                
                                                
                                                <a href="insurance.html" onMouseOver="document.images['img13'].src='widgets/gen_802.1.gif'" onMouseOut="document.images['img13'].src='widgets/gen_801.1.gif'"><img src="widgets/gen_801.1.gif" alt="Insurance" name="img13" border="0"></a><br>
                                                
                                                
                                                <a href="form.html" onMouseOver="document.images['img38'].src='widgets/gen_806.1.gif'" onMouseOut="document.images['img38'].src='widgets/gen_805.1.gif'"><img src="widgets/gen_805.1.gif" alt="Get A Quote" name="img38" border="0"></a><br>
                                                
                                                
                                                <a href="mirror.html" onMouseOver="document.images['img27'].src='widgets/gen_810.1.gif'" onMouseOut="document.images['img27'].src='widgets/gen_809.1.gif'"><img src="widgets/gen_809.1.gif" alt="Mirror Replacement " name="img27" border="0"></a><br>
                                                
                                                
                                                <a href="network.html" onMouseOver="document.images['img32'].src='widgets/gen_812.1.gif'" onMouseOut="document.images['img32'].src='widgets/gen_811.1.gif'"><img src="widgets/gen_811.1.gif" alt="Network" name="img32" border="0"></a><br>
                                                
                                                
                                                <a href="gpage.html" onMouseOver="document.images['img101'].src='widgets/gen_814.1.gif'" onMouseOut="document.images['img101'].src='widgets/gen_813.1.gif'"><img src="widgets/gen_813.1.gif" alt="Glass History" name="img101" border="0"></a><br>
                                                
                                                
                                                <a href="gpage1.html" onMouseOver="document.images['img140'].src='widgets/gen_820.1.gif'" onMouseOut="document.images['img140'].src='widgets/gen_819.1.gif'"><img src="widgets/gen_819.1.gif" alt="RV Glass" name="img140" border="0"></a><br>
                                                
                                                
                                                <a href="usedglass.html" onMouseOver="document.images['img143'].src='widgets/gen_824.1.gif'" onMouseOut="document.images['img143'].src='widgets/gen_823.1.gif'"><img src="widgets/gen_823.1.gif" alt="Used Glass" name="img143" border="0"></a><br>
                                                
                                                
                                                <a href="guarantee.html" onMouseOver="document.images['img24'].src='widgets/gen_808.1.gif'" onMouseOut="document.images['img24'].src='widgets/gen_807.1.gif'"><img src="widgets/gen_807.1.gif" alt="Our Guarantee" name="img24" border="0"></a><br>
                                                
                                                
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                                            <TD WIDTH="100%" HEIGHT="247" VALIGN="top"   ALIGN="right"  BACKGROUND="widgets/gen_788.1.gif"><img src="widgets/gen_786.1.gif" border=0 width=527 height=247 alt=""></TD>    
                                        </TR>
                                        <TR>
                                            <TD WIDTH="100%" HEIGHT="100%" VALIGN="top"><!-- BOF: ./personal-templates/simple/business/form/html -->
<!-- BOF: ./personal-templates/simple/personal/form/html -->


<center><table border=0>
<tr><td>


<font face='Arial' size='+1' color='#0F5DC4'>

Quote Form

</font>


<br>
<SCRIPT LANGUAGE="JavaScript">
var BUILDER = '/servlet/psoft.masonry.Builder';
function validate(frm){
var i = 0;

if (frm.field_42.value=="") return error(frm.field_42);

if (frm.field_43.value=="") return error(frm.field_43);

if (frm.field_44.value=="") return error(frm.field_44);

if (frm.field_46.value=="") return error(frm.field_46);

if (frm.field_47.value=="") return error(frm.field_47);

if (frm.field_56.value=="") return error(frm.field_56);

if (frm.field_127.value=="") return error(frm.field_127);

if (frm.field_53.value=="") return error(frm.field_53);

if (frm.field_54.value=="") return error(frm.field_54);

if (frm.field_55.value=="") return error(frm.field_55);

for(i = 0; i < frm.field_58.length; i++)
if (frm.field_58[i].checked) break;
if (frm.field_58.length==i) return error(frm.field_58[0]);

var url = document.URL;
if (url.indexOf(BUILDER) == -1 && url.charAt(url.length)!='/') {
    url = url.substring(0, url.lastIndexOf('/')+1);
}
frm.domain.value=url;
return true;
}
function error(field){ alert('You did not fill all required fields!'); field.focus(); return false; }
</SCRIPT>
<form name="questionary" action="http://209.217.50.104:8080/servlet/psoft.customform.CustomForm" method="post">
<input type="hidden" name="domain" value="">
<input type="hidden" name="title" value="Quote Form">
<input type="hidden" name="esubj" value="Submitted Form Report">
<input type="hidden" name="name" value="=GghoWXsbVRbLl=b">
<input type="hidden" name="submit_url" value="onsubmit.html">
<input type="hidden" name="error_url"  value="onerror.html">
<input type="hidden" name="order" value="42 43 44 46 47 48 56 127 52 53 54 55 58 60 59 d61 62 165 ">
<table border=0 cellpedding=5 cellspacing=5>

<input type="hidden" name="name_42" value="Year">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Year

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_42" size="">


</td></tr>

<input type="hidden" name="name_43" value="Make">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Make

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_43" size="">


</td></tr>

<input type="hidden" name="name_44" value="Model">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Model

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_44" size="">


</td></tr>

<input type="hidden" name="name_46" value="Glass Part(s) Needed">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Glass Part(s) Needed

</font>


 <font color="red" size="-1">*</font></td><td>


<textarea name="field_46" rows="" cols=""></textarea>

</td></tr>

<input type="hidden" name="name_47" value="Name">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Name

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_47" size="">


</td></tr>

<input type="hidden" name="name_48" value="Company">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Company

</font>


 </td><td>


<input type="text" name="field_48" size="">


</td></tr>

<input type="hidden" name="name_56" value="Phone #">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Phone #

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_56" size="">


</td></tr>

<input type="hidden" name="name_127" value="E-Mail">
<tr><td>


<font face='Arial' size='2' color='#000000'>

E-Mail

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_127" size="">


</td></tr>

<input type="hidden" name="name_52" value="Address">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Address

</font>


 </td><td>


<input type="text" name="field_52" size="">


</td></tr>

<input type="hidden" name="name_53" value="City">
<tr><td>


<font face='Arial' size='2' color='#000000'>

City

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_53" size="">


</td></tr>

<input type="hidden" name="name_54" value="State">
<tr><td>


<font face='Arial' size='2' color='#000000'>

State

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_54" size="">


</td></tr>

<input type="hidden" name="name_55" value="Zip Code">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Zip Code

</font>


 <font color="red" size="-1">*</font></td><td>


<input type="text" name="field_55" size="">


</td></tr>

<input type="hidden" name="name_58" value="Will you be using your Insurance">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Will you be using your Insurance

</font>


 <font color="red" size="-1">*</font></td><td>

<input type="radio" name="field_58" id="field_581" value="Yes"><label for="field_581">


<font face='Arial' size='2' color='#000000'>

Yes

</font>


</label> <input type="radio" name="field_58" id="field_582" value="No"><label for="field_582">


<font face='Arial' size='2' color='#000000'>

No

</font>


</label>


</td></tr>

<input type="hidden" name="name_60" value="Insurance Company">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Insurance Company

</font>


 </td><td>


<input type="text" name="field_60" size="">


</td></tr>

<input type="hidden" name="name_59" value="Insurance deductible">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Insurance deductible

</font>


 </td><td>


<input type="text" name="field_59" size="">


</td></tr>

<input type="hidden" name="name_61" value="Date of Lose/ Damage">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Date of Lose/ Damage

</font>


 </td><td>


<select name="field_m_61" 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_61" 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_61" size="4" maxsize="4">

</td></tr>

<input type="hidden" name="name_62" value="Cause and locationof Damage">
<tr><td>


<font face='Arial' size='2' color='#000000'>

Cause and locationof Damage

</font>


 </td><td>


<textarea name="field_62" rows="" cols=""></textarea>

</td></tr>

<input type="hidden" name="name_165" value="">
<tr><td>


<font face='Arial' size='2' color='#000000'>


</font>


 </td><td>
<input type="radio" name="field_165" id="field_1651" value="True"><label for="field_1651">


<font face='Arial' size='2' color='#000000'>

True

</font>


</label> <input type="radio" name="field_165" id="field_1652" value="False"><label for="field_1652">


<font face='Arial' size='2' color='#000000'>

False

</font>


</label>


</td></tr>

<tr><td colspan=2 align=center>
    <input onClick="return validate(form)" type="submit" value="Submit">
    <input type="reset"  value="Reset">
    </td>
</tr>
</table>
</form>
</td></tr></table></center>
<!-- EOF: ./personal-templates/simple/personal/form/html -->

<!-- EOF: ./personal-templates/simple/business/form/html -->
<br></TD>
                                        </TR>
                                    </TABLE>
                                </TD>
                                <TD WIDTH="99" HEIGHT="100%" VALIGN="top">
                                    <TABLE WIDTH="100%" HEIGHT="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top" BGCOLOR="#FFFFFF">
                                        <TR>
                                            <TD WIDTH="99" VALIGN="top"><img src="widgets/gen_789.1.gif" border=0 width=99 height=326 alt=""></TD>    
                                        </TR>
                                        <TR>
                                            <TD WIDTH="99" HEIGHT="100%" VALIGN="top" BGCOLOR="#243FAD" BACKGROUND="widgets/gen_790.1.gif"><img src="widgets/gen_790.1.gif" border=0 width=99 height=1 alt=""></TD>    
                                        </TR>
                                        <TR>
                                            <TD WIDTH="99" VALIGN="top"><img src="widgets/gen_791.1.gif" border=0 width=99 height=138 alt=""></TD>    
                                        </TR>
                                    </TABLE>
                               </TD>
                               <TD WIDTH="10%" HEIGHT="100%" VALIGN="top">
                                    <TABLE WIDTH="100%" HEIGHT="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top" BGCOLOR="#FFFFFF">
                                        <TR>
                                            <TD WIDTH="100%" VALIGN="top" BACKGROUND="widgets/gen_792.1.gif" style="background-repeat: repeat-x;"><img src="widgets/spacer.gif" height=326 width=5 alt=""></TD>       
                                        </TR>
                                        <TR>
                                            <TD WIDTH="100%" HEIGHT="100%" VALIGN="top" BGCOLOR="#243FAD"><img src="widgets/spacer.gif" height=1 width=1 alt=""></TD>       
                                        </TR>
                                        <TR>
                                            <TD WIDTH="100%" VALIGN="top"><img src="widgets/spacer.gif" height=138 width=1 alt=""></TD>       
                                        </TR>
                                    </TABLE>
                                </TD>
                            </TR>
                        </TABLE>
                    </TD>
                </TR>
                <TR>
                    <TD WIDTH="100%" VALIGN="top">
                        <TABLE WIDTH="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top" BGCOLOR="#FFFFFF">
                            <TR>
                                <TD WIDTH="100%" HEIGHT="55" BGCOLOR="#E9E9E9" VALIGN="top"><img src="widgets/spacer.gif" height=5 width=5 alt=""></TD>
                            </TR>
                        </TABLE>
                    </TD>
                </TR>
                <TR>
                    <TD WIDTH="100%" VALIGN="top">
                        <TABLE WIDTH="100%" BORDER="0" CELLPADDING="0" CELLSPACING="0" VALIGN="top" BGCOLOR="#FFFFFF">
                            <TR>
                                <TD WIDTH="174" HEIGHT="55" VALIGN="top" ><img src="widgets/spacer.gif" height=5 width=174 alt=""></TD>
                                <TD WIDTH="100%" HEIGHT="55" VALIGN="top">
<center><table border="0" cellpadding="0" cellspacing="3"><tr><td align="center">
<a href="http://www.shelbyautoglass.com/index.html"><img border="0" name="custom_logo" src="images/shelbylogo.gif"></a>
<br>
<font face="helvetica,verdana, arial" size="1">©1999 - 2008 DShelby Inc. All Rights Reserved </font>

</td></tr></table></center>
<br>

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

<nobr>|<a href="locations.html">Locations</A>|</nobr>

<nobr>|<a href="dealersbodyshop.html">Dealers / B.Shop</A>|</nobr>

<nobr>|<a href="fleet.html">Fleet</A>|</nobr>

<nobr>|<a href="insurance.html">Insurance</A>|</nobr>

<nobr>|Get A Quote|</nobr>

<nobr>|<a href="mirror.html">Mirror Replacement </A>|</nobr>

<nobr>|<a href="network.html">Network</A>|</nobr>

<nobr>|<a href="gpage.html">Glass History</A>|</nobr>

<nobr>|<a href="gpage1.html">RV Glass</A>|</nobr>

<nobr>|<a href="usedglass.html">Used Glass</A>|</nobr>

<nobr>|<a href="guarantee.html">Our Guarantee</A>|</nobr>

<nobr>|<a href="form1.html">Jobs @ Shelby</A>|</nobr>

<nobr>|<a href="contact.html">Contact Us</A>|</nobr>

<nobr>|<a href="HowDidWeDo.html">How did we do?</A>|</nobr>
</center>
</font>

<br></TD>    
                                <TD WIDTH="99" HEIGHT="55" VALIGN="top" ><img src="widgets/spacer.gif" height=5 width=99 alt=""></TD>       
                            </TR>
                        </TABLE>
                    </TD>
                </TR>
            </TABLE>
        </TD>
    </TR>
</TABLE>
<!-- end html -->
                
<!-- EOF: ./personal-templates/simple/business/layout/l88.layout -->

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


<script language="javascript">
	if (document.images)
	var staticlogo=new Image()
	staticlogo.src="";
	var logolink = "index.html"
	var alttext=""

	var dist_vert=0


	var dist_hor=0


	var fadeintoview=0;
	var fade_dur=0;
;

	var visibleduration=0; 

	var placement=3;  
</script>
<script language="javascript1.2" src="widgets/staticlogo1.js"></script>

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

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


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


</html>


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