Tots In Mind, Inc. Leaders in Child Safety Products

<body bgcolor="FFFFFF"> <CENTER> <table width=560> <tr> <td rowspan=2 width=187><img src="../images/infobut.gif" width="187" height="38"></td> <td><h2><i>Peace of mind from Tots in Mind</i> ® </td> </tr> <tr> <td align=center colspan=2> <img src="../images/dividersm.gif" width="346" height="13"></td> </tr> <tr> <td colspan=2><h5>When it comes to the safety of your infant or toddler, Tots in Mind understands your needs.<br> If you are interested in receiving information regarding retail stores or dealers who carry our products please call toll free 1-800-626-0339 or complete and submit the form below to receive an information package and structured pricing.<br><br><b>ATTENTION RETAIL BUYERS AND DISTRIBUTORS:</b> <br> If you are a representative of a retail store or distributor and are interested in learning more about the Tots in Mind or Terry Travel Product line, please <a href="../contact" target=_top>contact us</a> to speak to a representative.</td> </tr> </table> </center> <FORM METHOD="POST" ACTION="../cgi-bin/FormMail.pl"> <input type=hidden name="recipient" value="dianehm@rubyshoe.com"> <input type=hidden name="required" value="First Name,Last Name,Address,City,State,Zip Code,Phone,Products"> <CENTER> <table width="473" border="0" cellspacing="0" cellpadding="0"> <TR> <td align="RIGHT"> <FONT SIZE="1">*First Name </font> </TD> <TD>  <INPUT TYPE="text" NAME="First Name" maxlength=18 VALUE="" SIZE=18 MAXLENGTH=30> </TD> <td align="RIGHT"> <FONT SIZE="1"> <NOBR> *Last Name </NOBR> </FONT> </TD> <td valign="MIDDLE"> <INPUT TYPE="text" NAME="Last Name" maxlength=18 VALUE="" SIZE=18 MAXLENGTH=30> </TD> </TR> <TR> <TD align=right> <FONT SIZE="1">*Address</FONT> </TD> <TD>  <INPUT TYPE="text" NAME="Address" maxlength=30 VALUE="" SIZE=18 MAXLENGTH=30> </TD> <TD align=right> <FONT SIZE="1">*City </FONT> </TD> <TD> <INPUT TYPE="text" NAME="City" maxlength=30 VALUE="" SIZE=18 MAXLENGTH=30> </TD> </TR> <TR> <TD align=right><FONT SIZE="1" >*State</FONT> </TD> <TD>  <SELECT NAME="State" SIZE=1> <OPTION VALUE="">Click to Select <OPTION VALUE="AL">Alabama <OPTION VALUE="AK">Alaska <OPTION VALUE="AZ">Arizona <OPTION VALUE="AR">Arkansas <OPTION VALUE="CA">California <OPTION VALUE="CO">Colorado <OPTION VALUE="CT">Connecticut <OPTION VALUE="DE">Delaware <OPTION VALUE="DC">District of Columbia <OPTION VALUE="FL">Florida <OPTION VALUE="GA">Georgia <OPTION VALUE="HI">Hawaii <OPTION VALUE="ID">Idaho <OPTION VALUE="IL">Illinois <OPTION VALUE="IN">Indiana <OPTION VALUE="IA">Iowa <OPTION VALUE="KS">Kansas <OPTION VALUE="KY">Kentucky <OPTION VALUE="LA">Louisiana <OPTION VALUE="ME">Maine <OPTION VALUE="MD">Maryland <OPTION VALUE="MA">Massachusetts <OPTION VALUE="MI">Michigan <OPTION VALUE="MN">Minnesota <OPTION VALUE="MS">Mississippi <OPTION VALUE="MO">Missouri <OPTION VALUE="MT">Montana <OPTION VALUE="NE">Nebraska <OPTION VALUE="NV">Nevada <OPTION VALUE="NH">New Hampshire <OPTION VALUE="NJ">New Jersey <OPTION VALUE="NM">New Mexico <OPTION VALUE="NY">New York <OPTION VALUE="NC">North Carolina <OPTION VALUE="ND">North Dakota <OPTION VALUE="OH">Ohio <OPTION VALUE="OK">Oklahoma <OPTION VALUE="OR">Oregon <OPTION VALUE="PA">Pennsylvania <OPTION VALUE="RI">Rhode Island <OPTION VALUE="SC">South Carolina <OPTION VALUE="SD">South Dakota <OPTION VALUE="TN">Tennessee <OPTION VALUE="TX">Texas <OPTION VALUE="UT">Utah <OPTION VALUE="VT">Vermont <OPTION VALUE="VA">Virginia <OPTION VALUE="WA">Washington <OPTION VALUE="WV">West Virginia <OPTION VALUE="WI">Wisconsin <OPTION VALUE="WY">Wyoming </SELECT> </TD> <TD ALIGN=RIGHT> <FONT SIZE="1">*ZIP Code</FONT> </TD> <TD> <INPUT TYPE="text" NAME="Zip Code" maxlength=10 VALUE="" SIZE=18> </TD> </TR> <TR> <TD align=right> <FONT SIZE="1">Email Address</FONT> </TD> <TD>  <INPUT TYPE="text" NAME="email1" SIZE=18 MAXLENGTH="80"> </TD> <TD ALIGN=RIGHT> <FONT SIZE="1">*Phone </FONT> </TD> <TD> <INPUT TYPE="text" NAME="Phone" VALUE="" SIZE=18 MAXLENGTH=20> </TD> </TR> <TR> <TD align=right><FONT SIZE="1" >Company</FONT> </TD><td>  <INPUT TYPE="text" NAME="Company" VALUE="" SIZE=18 MAXLENGTH=20></td> <TD ALIGN=RIGHT> <FONT SIZE="1">Fax Number </FONT> </TD> <TD> <INPUT TYPE="text" NAME="Fax Number" VALUE="" SIZE=18 MAXLENGTH=20> </TD> </TR> <tr> <TD align=right><FONT SIZE="1" >*Products</FONT> </TD> <TD colspan=5>  <SELECT NAME="Products" SIZE=1> <OPTION VALUE="">Click to Select<option>Tots in Mind Original Cozy Crib Tent <option> Tots in Mind Cozy Portable Playard Plus Cabana Kit <option>Tots in Mind Baby's all-in-one Portable Pouch <option>Tots in Mind Baby's Bug Net System<option>Terry Travel Towel Bag</select> </TD> </TR> </table> </center> <center> <table width=450> <tr> <td align=center> <h5><font color="#233D2F">* required fields</h5></font></td></tr></table></center> <center> <table width=450> <tr> <tr> <td align=center><h5><font color="#233D2F"> <p>Please provide any additional comments in the space provided below:<br><br> <textarea WRAP=PHYSICAL name="description" rows=8 cols=50> </textarea> </P></h5></font> </td> </tr> </table> </center> <br><br> <center> <input TYPE="submit" VALUE="Submit Form"> <input TYPE="reset" NAME="Clear" VALUE="Clear Form"> </FORM> <br><br> </center> <center> <table width="470"> <center> <table width="470" cellspacing="0"> <tr> <td align="center"> <h6><a href="../index.htm" target="_top">Home</a>| <a href="../products" target="_top">Products </a>| <a href="https://www.innovativedist.com/form/index.html" target="topframe">Order Online</a>| <a href="../contact" target="_top">Contact Us</a> </h6> </td> </tr> </table> </center> <br> <center><hr width="60%"><table width="500"><tr><td align="center"><a href="http://www.rubyshoe.com" target="topframe"><img src="../images/rubybut1.gif" width="234" height="38"></a><h5><font color="#000084">©1999, all rights reserved</h5></font></td></tr></table> </center> </BODY>