====== Client - Updated Information ======
In order to update our dispatch software and accounting system, we would like you to answer the questions below. This will allow us to have your accurate and current information in the future.

<form>
Action script emailcsv.php

Labels :en:labels:logistique:forms:complete-client-information

Thanks "Thank you for confirming your information"

Hidden to "=account@alblogistique.com"
Hidden from "=no-reply@albcie.com"
Hidden subject "=@FORMPAGE_!!PAGE@"
Hidden showFieldSet "=0"
Hidden filename "=@FORMPAGE_FILE@"
Hidden append "=1"
Hidden namespace "=plugin:bureaucracy"
Hidden debug "=0"

Fieldset "Company Information"
Textbox CompanyName
Textbox CompanyLegalName
Textbox Industry
Textbox Website
Email Email
Textbox Address
Textbox City
Textbox State
Textbox ZipCode
Select Country "Canada|United States|Afghanistan|Albania|Algeria|Andorra|Angola|Antigua and Barbuda|Argentina|Armenia|Australia|Austria|Azerbaijan|Bahamas|Bahrain|Bangladesh|Barbados|Belarus|Belgium|Belize|Benin|Bhutan|Bolivia|Bosnia and Herzegovina|Botswana|Brazil|Brunei|Bulgaria|Burkina Faso|Burundi|Cambodia|Cameroon|Cape Verde|Central African Republic|Chad|Chile|China|Colombia|Comoros|Congo, Democratic Republic of the|Congo, Republic of the|Costa Rica|Côte d'Ivoire|Croatia|Cuba|Cyprus|Czech Republic|Denmark|Djibouti|Dominica|Dominican Republic|East Timor (Timor-Leste)|Ecuador|Egypt|El Salvador|Equatorial Guinea|Eritrea|Estonia|Eswatini|Ethiopia|Fiji|Finland|France|Gabon|Gambia, The|Georgia|Germany|Ghana|Greece|Grenada|Guatemala|Guinea|Guinea-Bissau|Guyana|Haiti|Honduras|Hungary|Iceland|India|Indonesia|Iran|Iraq|Ireland|Israel|Italy|Jamaica|Japan|Jordan|Kazakhstan|Kenya|Kiribati|Korea, North|Korea, South|Kosovo|Kuwait|Kyrgyzstan|Laos|Latvia|Lebanon|Lesotho|Liberia|Libya|Liechtenstein|Lithuania|Luxembourg|Madagascar|Malawi|Malaysia|Maldives|Mali|Malta|Marshall Islands|Mauritania|Mauritius|Mexico|Micronesia, Federated States of|Moldova|Monaco|Mongolia|Montenegro|Morocco|Mozambique|Myanmar (Burma)|Namibia|Nauru|Nepal|Netherlands|New Zealand|Nicaragua|Niger|Nigeria|North Macedonia (formerly Macedonia)|Norway|Oman|Pakistan|Palau|Panama|Papua New Guinea|Paraguay|Peru|Philippines|Poland|Portugal|Qatar|Romania|Russia|Rwanda|Saint Kitts and Nevis|Saint Lucia|Saint Vincent and the Grenadines|Samoa|San Marino|Sao Tome and Principe|Saudi Arabia|Senegal|Serbia|Seychelles|Sierra Leone|Singapore|Slovakia|Slovenia|Solomon Islands|Somalia|South Africa|South Sudan|Spain|Sri Lanka|Sudan|Suriname|Sweden|Switzerland|Syria|Taiwan|Tajikistan|Tanzania|Thailand|Togo|Tonga|Trinidad and Tobago|Tunisia|Turkey|Turkmenistan|Tuvalu|Uganda|Ukraine|United Arab Emirates|United Kingdom|Uruguay|Uzbekistan|Vanuatu|Vatican City|Venezuela|Vietnam|Yemen|Zambia|Zimbabwe"
Textbox Phone
Textbox TollFree
Textbox Fax
Select Language "French|English"
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Fieldset "Taxes"
Textbox TaxID
Select TaxCountry "Canada|United States|Afghanistan|Albania|Algeria|Andorra|Angola|Antigua and Barbuda|Argentina|Armenia|Australia|Austria|Azerbaijan|Bahamas|Bahrain|Bangladesh|Barbados|Belarus|Belgium|Belize|Benin|Bhutan|Bolivia|Bosnia and Herzegovina|Botswana|Brazil|Brunei|Bulgaria|Burkina Faso|Burundi|Cambodia|Cameroon|Cape Verde|Central African Republic|Chad|Chile|China|Colombia|Comoros|Congo, Democratic Republic of the|Congo, Republic of the|Costa Rica|Côte d'Ivoire|Croatia|Cuba|Cyprus|Czech Republic|Denmark|Djibouti|Dominica|Dominican Republic|East Timor (Timor-Leste)|Ecuador|Egypt|El Salvador|Equatorial Guinea|Eritrea|Estonia|Eswatini|Ethiopia|Fiji|Finland|France|Gabon|Gambia, The|Georgia|Germany|Ghana|Greece|Grenada|Guatemala|Guinea|Guinea-Bissau|Guyana|Haiti|Honduras|Hungary|Iceland|India|Indonesia|Iran|Iraq|Ireland|Israel|Italy|Jamaica|Japan|Jordan|Kazakhstan|Kenya|Kiribati|Korea, North|Korea, South|Kosovo|Kuwait|Kyrgyzstan|Laos|Latvia|Lebanon|Lesotho|Liberia|Libya|Liechtenstein|Lithuania|Luxembourg|Madagascar|Malawi|Malaysia|Maldives|Mali|Malta|Marshall Islands|Mauritania|Mauritius|Mexico|Micronesia, Federated States of|Moldova|Monaco|Mongolia|Montenegro|Morocco|Mozambique|Myanmar (Burma)|Namibia|Nauru|Nepal|Netherlands|New Zealand|Nicaragua|Niger|Nigeria|North Macedonia (formerly Macedonia)|Norway|Oman|Pakistan|Palau|Panama|Papua New Guinea|Paraguay|Peru|Philippines|Poland|Portugal|Qatar|Romania|Russia|Rwanda|Saint Kitts and Nevis|Saint Lucia|Saint Vincent and the Grenadines|Samoa|San Marino|Sao Tome and Principe|Saudi Arabia|Senegal|Serbia|Seychelles|Sierra Leone|Singapore|Slovakia|Slovenia|Solomon Islands|Somalia|South Africa|South Sudan|Spain|Sri Lanka|Sudan|Suriname|Sweden|Switzerland|Syria|Taiwan|Tajikistan|Tanzania|Thailand|Togo|Tonga|Trinidad and Tobago|Tunisia|Turkey|Turkmenistan|Tuvalu|Uganda|Ukraine|United Arab Emirates|United Kingdom|Uruguay|Uzbekistan|Vanuatu|Vatican City|Venezuela|Vietnam|Yemen|Zambia|Zimbabwe"

Fieldset "Main Contact"
Static MainContactInfo
Textbox MainContactFullname
Textbox MainContactTitle
Textbox MainContactPhone
Textbox MainContactMobile
Textbox MainContactEmail

Fieldset "Pick-up and Delivery Contact"
Textbox DeliveryAndPickupFullname !
Textbox DeliveryAndPickupTitle !
Textbox DeliveryAndPickupPhone !
Textbox DeliveryAndPickupMobile !
Textbox DeliveryAndPickupEmail !

Fieldset "Accounting Contact"
Textbox BillingFullname
Textbox BillingTitle
Textbox BillingPhone
Textbox BillingMobile
Textbox BillingEmailInvoice
Textbox BillingEmailStatement

Fieldset "Shipping Requirements"
Static ShippingRequirementsTagLine
YesNo ShippingRequirementsTailgate
YesNo ShippingRequirementsInsideDelivery
YesNo ShippingRequirementsBTrain
YesNo ShippingRequirementsDoubleDeck
YesNo ShippingRequirementsDropDeck
YesNo ShippingRequirementsDryVan
YesNo ShippingRequirementsFlatBed
YesNo ShippingRequirementsJigger
YesNo ShippingRequirementsReefer
YesNo ShippingRequirementsRolltite
YesNo ShippingRequirementsStepDeck
YesNo ShippingRequirementsStraightBody
YesNo ShippingRequirementsTailGate
YesNo ShippingRequirementsWhiteGloveService

Fieldset "Appointment"
YesNo AppointmentRequired

Fieldset "Warehouse hours of operation"
Select OpenHoursMondayFrom "Closed|00:00|01:00|02:00|03:00|04:00|05:00|06:00|07:00|08:00|09:00|10:00|11:00|12:00|13:00|14:00|15:00|16:00|17:00|18:00|19:00|20:00|21:00|22:00|23:00"
Select OpenHoursMondayTo "Closed|00:00|01:00|02:00|03:00|04:00|05:00|06:00|07:00|08:00|09:00|10:00|11:00|12:00|13:00|14:00|15:00|16:00|17:00|18:00|19:00|20:00|21:00|22:00|23:00"
Select OpenHoursTuesdayFrom "Closed|00:00|01:00|02:00|03:00|04:00|05:00|06:00|07:00|08:00|09:00|10:00|11:00|12:00|13:00|14:00|15:00|16:00|17:00|18:00|19:00|20:00|21:00|22:00|23:00"
Select OpenHoursTuesdayTo "Closed|00:00|01:00|02:00|03:00|04:00|05:00|06:00|07:00|08:00|09:00|10:00|11:00|12:00|13:00|14:00|15:00|16:00|17:00|18:00|19:00|20:00|21:00|22:00|23:00"
Select OpenHoursWednesdayFrom "Closed|00:00|01:00|02:00|03:00|04:00|05:00|06:00|07:00|08:00|09:00|10:00|11:00|12:00|13:00|14:00|15:00|16:00|17:00|18:00|19:00|20:00|21:00|22:00|23:00"
Select OpenHoursWednesdayTo "Closed|00:00|01:00|02:00|03:00|04:00|05:00|06:00|07:00|08:00|09:00|10:00|11:00|12:00|13:00|14:00|15:00|16:00|17:00|18:00|19:00|20:00|21:00|22:00|23:00"
Select OpenHoursThursdayFrom "Closed|00:00|01:00|02:00|03:00|04:00|05:00|06:00|07:00|08:00|09:00|10:00|11:00|12:00|13:00|14:00|15:00|16:00|17:00|18:00|19:00|20:00|21:00|22:00|23:00"
Select OpenHoursThursdayTo "Closed|00:00|01:00|02:00|03:00|04:00|05:00|06:00|07:00|08:00|09:00|10:00|11:00|12:00|13:00|14:00|15:00|16:00|17:00|18:00|19:00|20:00|21:00|22:00|23:00"
Select OpenHoursFridayFrom "Closed|00:00|01:00|02:00|03:00|04:00|05:00|06:00|07:00|08:00|09:00|10:00|11:00|12:00|13:00|14:00|15:00|16:00|17:00|18:00|19:00|20:00|21:00|22:00|23:00"
Select OpenHoursFridayTo "Closed|00:00|01:00|02:00|03:00|04:00|05:00|06:00|07:00|08:00|09:00|10:00|11:00|12:00|13:00|14:00|15:00|16:00|17:00|18:00|19:00|20:00|21:00|22:00|23:00"

Fieldset "Accessibility"
YesNo AccessibilityHighwayTrucks
YesNo AccessibilityCityTrucks
YesNo AccessibilityDock
YesNo AccessibilityNoTouch
YesNo AccessibilityTailgate

Fieldset "Custom Broker Information"
Select CustomsBrokerImport "ALB Custom Trade|H.Kennedy|W2C|Cole|Livingston|Eurofret|Other|None"
Select CustomsBrokerExport "A.N.Deringer|BCB INTL|Agility|CH Robinson|Livingston|Other|None"

Fieldset "Specify the name of your import broker" CustomsBrokerImport "Other"
Textbox CustomsBrokerImportOther !

Fieldset "Specify the name of your export broker" CustomsBrokerExport "Other"
Textbox CustomsBrokerExportOther !

Fieldset "Operation Reports"
Textbox OperationReportEmail

Submit Submit
</form>