<style type="text/css">
	#kpfg_header{ width:800px; height:180px; background:url(http://doclibrary.com/MFR457/IMG/bif_bg.jpg) no-repeat; }
		#kpfg_header h1 { color:#ffffff; font-size:22px; margin-bottom:3px;}
		#kpfg_header p { color:#ffffff; font-size:12px; margin-bottom:10px; }
	.kpfg { width:800px; }

	.kpfg h1 { margin-top:2.5em; margin-bottom:.5em; text-align:center; color: #ED1C24;}
	.kpfg h2 { font-size:0.875em; margin-top:1em; margin-bottom:1em; text-align:left;  color: #000000;}
		.kpfg h2 span { color:#d23239; }

	.kpfg table.requestorblock { width:800px; font-size:0.875em; }
	.kpfg table.requestorblock span { color:#d23239; }
	.kpfg table.requestorblock td { padding: 3px; } 
	.kpfg table.requestorblock td.l { width:140px; text-align:left;}
	.kpfg table.requestorblock td.l input { width:55px; background:#e6e7e8; border:0; }
	.kpfg table.requestorblock td.lx { width:780px; text-align:left;}
	.kpfg table.requestorblock td.rf { width:270px; }
	.kpfg table.requestorblock td.rf input { width:270px; background:#e6e7e8; border:0; }
	.kpfg table.requestorblock td.rffname { width:135px; }
	.kpfg table.requestorblock td.rffname input { width:49px; background:#e6e7e8; border:0; }
	.kpfg table.requestorblock td.rflname { width:135px; }
	.kpfg table.requestorblock td.rflname input { width:54px; background:#e6e7e8; border:0; }
	.kpfg table.requestorblock td.rfzip { width:270px; }
	.kpfg table.requestorblock td.rfzip input { width:203px; background:#e6e7e8; border:0; }
	.kpfg table.requestorblock td.rfx { width:670px; }
	.kpfg table.requestorblock td.rfx2 { width:800px; }
	.kpfg table.requestorblock td.rfx input { width:693px; background:#e6e7e8; border:0; }
	.kpfg table.requestorblock td.rfx3 { width:670px; }
	.kpfg table.requestorblock td.rfx3 input { width:693px; background:#e6e7e8; border:0; }
	.kpfg table.requestorblock td.rfx2 textarea { width:795px;height:45px; border:1px solid #000000; } 
	
	.pfi-form { margin-top:25px; margin-bottom:25px; border:1px solid #a93439; }
	.pfi-form td { padding:5px; border:1px solid #a93439; text-align:center; }
		.pfi-form td:first-child{ text-align:left; }
	.pfi-form th { padding:5px; background:#a93439; color:#ffffff; }
		.pfi-form th:first-child { text-align:left; }
	
	/*ie10 */	
	@media screen and (min-width:0\0) { 
    	.kpfg table.requestorblock td.rfzip input { width:209px; background:#e6e7e8; border:0; }
	}
</style>

<cfscript>
	variables._SALES_REP = "";
	variables._BROKERAGE = "";
	variables._BRK_ADDRESS = "";
	variables._BRK_CITY = "";
	variables._BRK_STATE = "";
	variables._BRK_ZIP = "";
	variables._BRK_PHONE = "";
	variables._BRK_EMAIL = "";
	variables._KPFGRGNMGR = "";
	variables._OPR_CUTTINGDATE = "01/01/13";
</cfscript>

<!--- <cfif isdefined("client.brokerId") and client.brokerId neq 0> --->
	<cfmodule template="queries/qmd_getUserInfo.cfm"
				dsn="#client.datasource#"
				OwnerID="#client.user_ownerId#"
				OwnerType="#client.user_ownerType#"
				FSPro_UserID="#client.ID#">
					
					<cfscript>
						variables._SALES_REP = "#variables.usrFirstName# #variables.usrLastName#";
						variables._BROKERAGE = variables.usrCompany;
						variables._BRK_ADDRESS = variables.usrStreetAddress;
						variables._BRK_CITY = variables.usrCity;
						variables._BRK_STATE = variables.usrState;
						variables._BRK_ZIP = variables.usrZip;
						variables._BRK_PHONE = variables.usrPhone;
						variables._BRK_EMAIL = variables.usrEmail;
						variables._KPFGRGNMGR = variables.usrRgnMgr;
					</cfscript>
<!--- </cfif> --->



<div class="kpfg">
	<!--- <h1>Consumer Brands Order Form</h1> --->
	<div>
		<h2>Broker Information <span>*Required</span></h2>
		<table class="requestorblock">
			<!--- broker information --->
			<tr>
				<td class="l">Sales Rep<span>*</span></td>
				<td class="rf"><cfmodule template="/mstrcfmod/CDA/cfmod_formXSLHelper.cfm" helper="field" fieldName="PLMURCPRO_SALES_REP" fieldDefaultValue="#variables._SALES_REP#" /></td>
				<td class="l">Brokerage<span>*</span></td>
	 			<td class="rf"><cfmodule template="/mstrcfmod/CDA/cfmod_formXSLHelper.cfm" helper="field" fieldName="PLMURCPRO_BROKERAGE" fieldDefaultValue="#variables._BROKERAGE#" /></td> 
			</tr>
			<tr>
				<td class="l">Address<span>*</span></td>
	 			<td class="rfx" colspan="3"><cfmodule template="/mstrcfmod/CDA/cfmod_formXSLHelper.cfm" helper="field" fieldName="PLMURCPRO_BRK_ADDRESS" fieldDefaultValue="#variables._BRK_ADDRESS#" /></td> 
			</tr>
			<tr>
				<td class="l">City<span>*</span></td>
				<td class="rf"><cfmodule template="/mstrcfmod/CDA/cfmod_formXSLHelper.cfm" helper="field" fieldName="PLMURCPRO_BRK_CITY" fieldDefaultValue="#variables._BRK_CITY#" /></td>
				<td class="l">State<span>*</span>&#160;<cfmodule template="/mstrcfmod/CDA/cfmod_formXSLHelper.cfm" helper="field" fieldName="PLMURCPRO_BRK_STATE" fieldDefaultValue="#variables._BRK_STATE#" /></td>
	 			<td class="rfzip">Zip Code<span>*</span>&#160;<cfmodule template="/mstrcfmod/CDA/cfmod_formXSLHelper.cfm" helper="field" fieldName="PLMURCPRO_BRK_ZIP" fieldDefaultValue="#variables._BRK_ZIP#" /></td> 
			</tr>
			<tr>
				<td class="l">Phone<span>*</span></td>
				<td class="rf"><cfmodule template="/mstrcfmod/CDA/cfmod_formXSLHelper.cfm" helper="field" fieldName="PLMURCPRO_BRK_PHONE" fieldDefaultValue="#variables._BRK_PHONE#" /></td>
				<td class="l">Email<span>*</span></td>
	 			<td class="rf"><cfmodule template="/mstrcfmod/CDA/cfmod_formXSLHelper.cfm" helper="field" fieldName="PLMURCPRO_BRK_EMAIL" fieldDefaultValue="#variables._BRK_EMAIL#" /></td> 
			</tr>
			<tr>
				<td class="l">KPFG Regional Manager<span>*</span></td>
	 			<td class="rfx" colspan="3"><cfmodule template="/mstrcfmod/CDA/cfmod_formXSLHelper.cfm" helper="field" fieldName="PLMURCPRO_KPFGRGNMGR" fieldDefaultValue="#variables._KPFGRGNMGR#" /></td> 
			</tr>
		</table>
		<h2>Operator Information <span>*Required</span></h2>
		<table class="requestorblock">
			<!--- operator information --->
			<tr>
				<td class="l">Operator<span>*</span></td>
	 			<td class="rf" colspan="2"><cfmodule template="/mstrcfmod/CDA/cfmod_formXSLHelper.cfm" helper="field" fieldName="PLMURCPRO_OPR_OPERATIONNAME"/></td> 
				<td class="l">No. of Units<span>*</span></td>
	 			<td class="rf"><cfmodule template="/mstrcfmod/CDA/cfmod_formXSLHelper.cfm" helper="field" fieldName="PLMURCPRO_OPR_NUMUNITS"/></td> 
			</tr>
			<tr>
				<td class="l">Main Address<span>*</span></td>
	 			<td class="rfx3" colspan="4"><cfmodule template="/mstrcfmod/CDA/cfmod_formXSLHelper.cfm" helper="field" fieldName="PLMURCPRO_OPR_ADDRESS"/></td> 
			</tr>
			<tr>
				<td class="l">City<span>*</span></td>
				<td class="rf" colspan="2"><cfmodule template="/mstrcfmod/CDA/cfmod_formXSLHelper.cfm" helper="field" fieldName="PLMURCPRO_OPR_CITY"/></td>
				<td class="l">State<span>*</span>&#160;<cfmodule template="/mstrcfmod/CDA/cfmod_formXSLHelper.cfm" helper="field" fieldName="PLMURCPRO_OPR_STATE"/></td>
	 			<td class="rfzip">Zip Code<span>*</span>&#160;<cfmodule template="/mstrcfmod/CDA/cfmod_formXSLHelper.cfm" helper="field" fieldName="PLMURCPRO_OPR_ZIP"/></td> 
			</tr>
			<tr>
				<td class="l">Contact Person:</td>
				<td class="rffname">First Name<span>*</span>&#160;<cfmodule template="/mstrcfmod/CDA/cfmod_formXSLHelper.cfm" helper="field" fieldName="PLMURCPRO_OPR_FIRSTNAME"/></td>
				<td class="rflname">Last Name<span>*</span>&#160;<cfmodule template="/mstrcfmod/CDA/cfmod_formXSLHelper.cfm" helper="field" fieldName="PLMURCPRO_OPR_LASTNAME"/></td>
				<td class="l">Title<span>*</span></td>
	 			<td class="rf"><cfmodule template="/mstrcfmod/CDA/cfmod_formXSLHelper.cfm" helper="field" fieldName="PLMURCPRO_OPR_CONTACTTITLE"/></td> 
			</tr>
			<tr>
				<td class="l">Phone<span>*</span></td>
				<td class="rf" colspan="2"><cfmodule template="/mstrcfmod/CDA/cfmod_formXSLHelper.cfm" helper="field" fieldName="PLMURCPRO_OPR_CONTACTPHONE"/></td>
				<td class="l">Email<span>*</span></td>
	 			<td class="rf"><cfmodule template="/mstrcfmod/CDA/cfmod_formXSLHelper.cfm" helper="field" fieldName="PLMURCPRO_OPR_CONTACTEMAIL"/></td> 
			</tr>
			<tr>
				<td class="l">Distributor<span>*</span></td>
	 			<td class="rf" colspan="2"><cfmodule template="/mstrcfmod/CDA/cfmod_formXSLHelper.cfm" helper="field" fieldName="PLMURCPRO_OPR_DISTR"/></td> 
				<td class="l">&#160;</td>
	 			<td class="rf">&#160;</td> 
			</tr>
		</table>
		<!---<h2>Product Information</h2> --->
		<table class="requestorblock pfi-form">
			<tr>
				<th>Product</th>
				<th>Showed<br />(check all that apply)</th>
				<th>Interested<br />(check all that apply)</th>
			</tr>
			<!--- <tr>
				<td><strong>Sauce Mixes</strong></td>
	 			<td></td>
				<td></td>
	 		</tr> --->
			<tr>
				<td>Pepper Jack Cheese Sauce 322T-T0701</td>
				<td><input type="Checkbox" name="PLMURCPRO_PRDROW_S1" value="1" /></td>
	 			<td><input type="Checkbox" name="PLMURCPRO_PRDROW_I1" value="1" /></td>
			</tr>
			<tr>
				<td>Classic Alfredo Sauce 090T-T0700</td>
	 			<td><input type="Checkbox" name="PLMURCPRO_PRDROW_S2" value="1" /></td>
	 			<td><input type="Checkbox" name="PLMURCPRO_PRDROW_I2" value="1" /></td>
			</tr>
			<tr>
				<td>Sweet Thai Chili Sauce V442-F6190</td>
	 			<td><input type="Checkbox" name="PLMURCPRO_PRDROW_S3" value="1" /></td>
	 			<td><input type="Checkbox" name="PLMURCPRO_PRDROW_I3" value="1" /></td>
			</tr>
			<tr>
				<td>Beef Gravy 325T-T0701</td>
	 			<td><input type="Checkbox" name="PLMURCPRO_PRDROW_S4" value="1" /></td>
	 			<td><input type="Checkbox" name="PLMURCPRO_PRDROW_I4" value="1" /></td>
			</tr>
			<tr>
				<td>Cilantro Lime Rice Seasoning S162-F6190</td>
	 			<td><input type="Checkbox" name="PLMURCPRO_PRDROW_S5" value="1" /></td>
	 			<td><input type="Checkbox" name="PLMURCPRO_PRDROW_I5" value="1" /></td>
			</tr>
			<tr>
				<td>Salsa Seasoning V425-H5190</td>
	 			<td><input type="Checkbox" name="PLMURCPRO_PRDROW_S6" value="1" /></td>
	 			<td><input type="Checkbox" name="PLMURCPRO_PRDROW_I6" value="1" /></td>
			</tr>
			<tr>
				<td>Ranch Dressing V400-JA190</td>
	 			<td><input type="Checkbox" name="PLMURCPRO_PRDROW_S7" value="1" /></td>
	 			<td><input type="Checkbox" name="PLMURCPRO_PRDROW_I7" value="1" /></td>
			</tr>
			<tr>
				<td>Ranch Dressing V402-JA190</td>
	 			<td><input type="Checkbox" name="PLMURCPRO_PRDROW_S8" value="1" /></td>
	 			<td><input type="Checkbox" name="PLMURCPRO_PRDROW_I8" value="1" /></td>
			</tr>
			<tr>
				<td>Simply Smoothies Base Mix Canisters D620-B5010</td>
	 			<td><input type="Checkbox" name="PLMURCPRO_PRDROW_S9" value="1" /></td>
	 			<td><input type="Checkbox" name="PLMURCPRO_PRDROW_I9" value="1" /></td>
			</tr>
			<tr>
				<td>Simply Smoothies Base Mix PCs D620-Y6010</td>
	 			<td><input type="Checkbox" name="PLMURCPRO_PRDROW_S10" value="1" /></td>
	 			<td><input type="Checkbox" name="PLMURCPRO_PRDROW_I10" value="1" /></td>
			</tr>
			<!--- <tr>
				<td><strong>Dressing Mixes</strong></td>
				<td></td>
				<td></td>
	 		</tr> --->
		</table>
		<h2>Additional Questions</h2>
		<table class="requestorblock">
			<tr>
				<td class="lx" colspan="4">What follow up is necessary?* (send samples, test, cutting against similar products, secondary presentation.</td>
	 		</tr>
			<tr>
				<td class="rfx2" colspan="4">
					<textarea name="PLMURCPRO_FOLLOWUP" rows="4" cols="400"></textarea>
				</td> 
			</tr>
			<tr>
				<td class="lx" colspan="4">Not interested, why?  Explain. (mixing, price, quality, distribution, labor, equipment)</td>
	 		</tr>
			<tr>
				<td class="rfx2" colspan="4">
					<textarea name="PLMURCPRO_NOTINTEREST" rows="4" cols="400"></textarea>
				</td> 
			</tr>
		</table>
	</div>
	<div class="buttons" style="text-align:center;margin-top:20px;">
		<cfmodule template="/mstrcfmod/CDA/cfmod_formXSLHelper.cfm" helper="button" class="submit"/>
		<!--- <cfmodule template="/mstrcfmod/WRK/bindings/helpers/button.cfm" class="reset"/> --->
	</div>
</div>

<cfoutput>

<script type="text/javascript"><![CDATA[
	document.cdaForm.PLMURCPRO_SALES_REP.value = '#JSStringFormat(variables._SALES_REP)#';
	document.cdaForm.PLMURCPRO_BROKERAGE.value = '#JSStringFormat(variables._BROKERAGE)#';
	document.cdaForm.PLMURCPRO_BRK_ADDRESS.value = '#JSStringFormat(variables._BRK_ADDRESS)#';
	document.cdaForm.PLMURCPRO_BRK_CITY.value = '#JSStringFormat(variables._BRK_CITY)#';
	document.cdaForm.PLMURCPRO_BRK_STATE.value = '#JSStringFormat(variables._BRK_STATE)#';
	document.cdaForm.PLMURCPRO_BRK_ZIP.value = '#JSStringFormat(variables._BRK_ZIP)#';
	document.cdaForm.PLMURCPRO_BRK_PHONE.value = '#JSStringFormat(variables._BRK_PHONE)#';
	document.cdaForm.PLMURCPRO_BRK_EMAIL.value = '#JSStringFormat(variables._BRK_EMAIL)#';
	document.cdaForm.PLMURCPRO_KPFGRGNMGR.value = '#JSStringFormat(variables._KPFGRGNMGR)#';
	document.cdaForm.PLMURCPRO_OPR_CUTTINGDATE.value = '#JSStringFormat(variables._OPR_CUTTINGDATE)#';
	]]></script>
</cfoutput>