" enctype="multipart/form-data" id="Form1">
<input type="hidden" name="formid" value="form1">
<label for="Editbox1" id="Label1">First Name</label>
<input type="text" id="Editbox1" name="First Name" value="" spellcheck="false">
<label for="Editbox2" id="Label2">Last Name</label>
<input type="text" id="Editbox2" name="Last Name" value="" spellcheck="false">
<label for="Editbox3" id="Label3">Street Address</label>
<input type="text" id="Editbox3" name="Address" value="" spellcheck="false">
<label for="Editbox4" id="Label4">City</label>
<input type="text" id="Editbox4" name="City" value="" spellcheck="false">
<label for="Editbox6" id="Label6">Zip Code</label>
<input type="number" id="Editbox6" name="Zipcode" value="" spellcheck="false">
<label for="Editbox7" id="Label7">Phone</label>
<input type="number" id="Editbox7" name="Phone" value="" spellcheck="false">
<label for="Editbox8" id="Label8">Email</label>
<input type="email" id="Editbox8" name="Email" value="" spellcheck="false">
<label for="Editbox9" id="Label9">Vehicle Year</label>
<input type="number" id="Editbox9" name="Vehicle Year" value="" maxlength="4" spellcheck="false">
<label for="Editbox10" id="Label10">Make</label>
<input type="text" id="Editbox10" name="Make" value="" spellcheck="false">
<label for="Editbox11" id="Label11">Model</label>
<input type="text" id="Editbox11" name="Model" value="" spellcheck="false">
<label for="Combobox1" id="Label12">Transmission</label>
<select name="Transmission" size="1" id="Combobox1" autocomplete="off">
<option value="Automatic">Automatic</option>
<option value="Manual">Manual</option>
</select>
<label for="Editbox12" id="Label13">License Plate</label>
<input type="text" id="Editbox12" name="License Plate" value="" spellcheck="false">
<label for="Editbox13" id="Label14">Odometer</label>
<input type="text" id="Editbox13" name="Odometer" value="" spellcheck="false">
<input type="date" id="Editbox14" name="Date Of Pickup" value="" spellcheck="false">
<label for="Combobox2" id="Label16">Location</label>
<select name="Location" size="1" id="Combobox2" autocomplete="off">
<option value="Home">Home</option>
<option value="Work">Work</option>
</select>
<input type="reset" id="Button1" name="" value="Reset">
<input type="submit" id="Button2" name="" value="Submit">
<label for="Combobox2" id="Label17">Time</label>
<select name="Time" size="1" id="Combobox3" autocomplete="off">
<option value="9:00 am">9:00 am</option>
<option value="10:00 AM">10:00 AM</option>
<option value="11:00 AM">11:00 AM</option>
<option value="12:00 PM">12:00 PM</option>
<option value="1:00 PM">1:00 PM</option>
<option value="1:00 PM">2:00 PM</option>
<option value="3:00 PM">3:00 PM</option>
<option value="4:00 PM">4:00 PM</option>
</select>
<input type="text" id="Editbox5" name="Discount Code" value="" spellcheck="false">
<label for="Editbox5" id="Label5">Discount Code</label>
</form>
</div>
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<label for="Editbox14" id="Label15">Date Of Pickup</label>
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<label class="toggle" for="ResponsiveMenu1-submenu" id="ResponsiveMenu1-title">Menu<span id="ResponsiveMenu1-icon"><span>&nbsp;</span><span>&nbsp;</span><span>&nbsp;</span></span></label>
<input type="checkbox" id="ResponsiveMenu1-submenu">
<ul class="nav ResponsiveMenu1" id="ResponsiveMenu1" role="menu">
<li class="nav" role="menuitem"><a href="./index.html" class="nav-link">Home</a></li>
<li class="nav" role="menuitem"><a href="./index.html#Bookmark1" class="nav-link">Our&nbsp;Services</a></li>
<li class="nav" role="menuitem"><a href="./Pricing.html" class="nav-link">Pricing</a></li>
<li class="nav" role="menuitem"><a href="./index.html#Bookmark2" class="nav-link">How&nbsp;It&nbsp;Works</a></li>
<li class="nav" role="menuitem"><a href="./Service_Request.php" class="nav-link">Service&nbsp;Request</a></li>
<li class="nav" role="menuitem"><a href="./QA.html" class="nav-link">Q&nbsp;&amp;&nbsp;A</a></li>
<li class="nav" role="menuitem"><a href="./Contact_Us.php" class="nav-link">Contact&nbsp;Us</a></li>
<li class="nav" role="menuitem"><a href="./index.html#Bookmark3" class="nav-link">Service&nbsp;Area</a></li>
<li class="nav" role="menuitem"><a href="./index.html#Bookmark4" class="nav-link">About&nbsp;us</a></li>
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