<div align="center">  <img src="library/images/contact_header.gif" /></div>
<p align="left">
Thank you for your interest in the EduKit school supply program!   When you complete this form, you will receive an email confirming that this form was successfully submitted.  Your EduKit Sales Representative will contact you directly to discuss your organization’s program.   If you would like to call us directly, please call <font color="#7fc31c"><strong><a href="tel:8666608854">(866) 660-8854</a></strong></font>.
</p>
<p align="left">
If you have an inquiry about a specific student’s order or for any other general inquiries, please complete our <a href="/customer-service">Customer Service form</a>.  You can also call us at <font color="#7fc31c"><strong><a href="tel:8666608854">(866) 660-8854</a></strong></font> to speak to one of our customer service representatives.
</p
<div style="width:600px;margin:auto;" id="crmWebToEntityForm">
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    <tbody>
    <tr><td colspan='2' style='text-align:left;color:black;font-family:Arial;font-size:14px;'><strong>School Information</strong></td>
    </tr>
    <tr><td  style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>First Name<span style='color:red;'>*</span></td>
    <td style='width:250px;' ><input type='text' style='width:250px;'  maxlength='40' name='First Name'/></td>
    </tr>
    <tr><td  style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>Last Name<span style='color:red;'>*</span></td>
    <td style='width:250px;' ><input type='text' style='width:250px;'  maxlength='80' name='Last Name' /></td>
    </tr>

    <tr><td  style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>Position</td><td style='width:250px;'>
        <select style='width:250px;' name='LEADCF9'>
            <option value='-None-'>-None-</option>
        <option selected value='School Coordinator'>School Coordinator</option>
            <option value='PTA Member'>PTA Member</option>
            <option value='School Administrator'>School Administrator</option>
            <option value='Teacher'>Teacher</option>
            <option value='Parent'>Parent</option>
        </select></td></tr>

    <tr><td  style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>Email<span style='color:red;'>*</span></td><td style='width:250px;' ><input type='text' style='width:250px;'  maxlength='100' name='Email' /></td></tr>

    <tr><td  style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>Phone</td><td style='width:250px;' ><input type='text' style='width:250px;'  maxlength='30' name='Phone' /></td>
</tr>
    <tr><td  style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>School Name<span style='color:red;'>*</span></td>
<td style="width:250px;"><input onkeyup="upperCase(this);" name="Company" maxlength="100" style="width:250px;" type="text" /></td>
</tr>

    <tr><td  style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>Street</td><td style='width:250px;' ><input type='text' style='width:250px;'  maxlength='250' name='Street' /></td></tr>

    <tr><td  style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>City<span style='color:red;'>*</span></td><td style='width:250px;' ><input type='text' style='width:250px;'  maxlength='30' name='City' /></td></tr>

    <tr><td  style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>State<span style='color:red;'>*</span></td><td style='width:250px;' ><input type='text' style='width:250px;'  maxlength='30' name='State' /></td></tr>

    <tr><td  style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>Grade Span</td><td style='width:250px;' ><input type='text' style='width:250px;'  maxlength='10' name='LEADCF4' /></td></tr>

    <tr><td  style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>Enrollment</td><td style='width:250px;' ><input type='text' style='width:250px;'  maxlength='10' name='LEADCF51' /></td></tr>

    <tr><td  style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>I am interested in</td><td style='width:250px;'>
        <select style='width:250px;' name='LEADCF10' multiple>
        <option selected value='Kit Program'>Kit Program</option>
            <option value='Bulk School Supplies'>Bulk School Supplies</option>
            <option value='Planners'>Planners</option>
            <option value='Other'>Other</option>
        </select></td><td><span>Ctrl + click or (Command + click on a Mac) to select all that apply</span></td>

    <tr><td  style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>How did you hear about us?</td>
    <td style='width:250px;'>   
        <select style='width:250px;' name='LEADCF11'>
       
            <option value='-None-'>-None-</option>
            <option value='Referral'>Referral</option>
            <option value='Internet Search'>Internet Search</option>
            <option value='Email'>Email</option>
            <option value='School Flyer'>School Flyer</option>
            <option value='Convention'>Convention</option>
            <option value='Other'>Other</option>
        </select></td>   
        </tr>

    <tr><td  style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>Referring School</td><td style='width:250px;' ><input type='text' style='width:250px;'  maxlength='255' name='LEADCF15' /></td><td><span>If you selected referral, please let us know the name of the referring school.</span></td></tr>
   
    <tr><td  style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>Send me a brochure</td><td style='width:250px;'>
        <select style='width:250px;' name='LEADCF12'>
            <option value='-None-'>-None-</option>
            <option value='Yes'>Yes</option>
            <option value='No'>No</option>
        </select></td></tr>

    <tr><td  style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>Tell us how we can help </td><td> <textarea name='Description' maxlength='1000' style='width:250px;'> </textarea></td></tr>

    <tr><td style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>Upload your supply list</td>
        <td style='padding-top: 10px;'><input type='file' name='theFile' id='theFile' multiple/><p style='color:black;font-size:11px;padding-left:3px;'>File(s) size limit is 20MB.</p></td>
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    <tr><td style='nowrap:nowrap;text-align:left;font-size:12px;font-family:Arial;width:200px;'>Type the characters below</td>
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        <a href='javascript:;' onclick='reloadImg()'>Reload</a></td>
    </tr>
    <tr><td colspan='2' style='text-align:center; padding-top:15px;'>
        <input style='font-size:12px;color:#131307' type='submit' value='Submit' />
        <input type='reset' style='font-size:12px;color:#131307' value='Reset' />
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