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<HTML>

<HEAD>


<META NAME="description" CONTENT="Affordable Custom Photo Cards & Personalized Stationery. From fresh& funky to cute&classic we are sure to have a design to suit your style and occasion. We also love to create custom designs! Bee original, never cookie cutter!">
<META NAME="Keywords"    CONTENT="photo birth announcement, photo birth announcements, birth announcement, birth announcements, photo baby announcement, baby announcement, photo baby announcements, baby announcements, picture birth announcement, picture birth announcement, adoption announcement, adoption announcements, photo adoption announcement, photo adoption announcements, photo holiday cards, photo birthday invitations, custom photo cards, photo baptism announcements">


<!-- business -->


<META HTTP-EQUIV="Content-Type" CONTENT="text/html; charset=UTF-8">
<META NAME="Generator" content="">
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<!--<BASE HREF="http://polkadotbumblebee.com/form5.html">-->
<TITLE>Survey</TITLE></head>
<BODY  BGCOLOR="#FFFFFF"
 TEXT="#000000"

LEFTMARGIN="0" TOPMARGIN="0" RIGHTMARGIN="0" BOTTOMMARGIN="0"

 onLoad=""
 
 LINK="#000000"
 VLINK="#000000"
 ALINK="#000000"
>

  
      <!-- BOF: ./personal-templates/simple/businessnew/layout/l14.layout --> 


<TABLE DIR="LTR" WIDTH=100% BORDER=0 CELLPADDING=0 CELLSPACING=0>
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                <TD WIDTH=169 HEIGHT=25 BGCOLOR=#FFFFFF>
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<TABLE DIR="LTR" WIDTH=100% BORDER=0 CELLPADDING=0 CELLSPACING=0>
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                <TD WIDTH=100% COLSPAN=2 BGCOLOR=#FFFFFF ALIGN="center" VALIGN="top" BACKGROUND="">
                <!-- BOF: ./personal-templates/simple/businessnew/form/style_l14.html -->


<br><table width="100%" border="0" cellpadding="0" cellspacing="0">
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<br>
<SCRIPT LANGUAGE="JavaScript">
function validate(frm){
var i = 0;

return true;
}
function error(field){ alert('You did not fill all required fields!'); field.focus(); return false; }
</SCRIPT>
<form name="questionary" action="http://build-your-site-here.com:8080/servlet/psoft.customform.CustomForm" method="post">
<input type="hidden" name="domain" value="">
<input type="hidden" name="title" value="Survey">
<input type="hidden" name="efrom" value="polkadotbumblebee@gmail.com">
<input type="hidden" name="email" value="polkadotbumblebee@gmail.com">
<input type="hidden" name="esubj" value="Submitted Form Report">
<input type="hidden" name="submit_url" value="onsubmit5.html">
<input type="hidden" name="error_url"  value="onerror5.html">
<input type="hidden" name="order" value="284 285 286 287 288 289 290 291 292 293 294 295 296 297 298 299 ">
<script>
var p = location.pathname;
if (p.charAt(p.length)!='/') {
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}
document.forms[0].domain.value = location.protocol+'//'+location.host+p;
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<center><table border=0>
<input type="hidden" name="name_284" value="Name">
<tr>
    <td><img src="widgets/gen_378.1.gif" border="0" align="absmiddle">


<font face='Arial' size='2' color='#000000'>

Name

</font>


    </td>
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<input type="hidden" name="name_285" value="Address if different from Pay Pal">
<tr>
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<font face='Arial' size='2' color='#000000'>

Address if different from Pay Pal

</font>


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<tr>
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<font face='Arial' size='2' color='#000000'>

Email

</font>


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<input type="hidden" name="name_287" value="Phone Number in case of ?s">
<tr>
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<font face='Arial' size='2' color='#000000'>

Phone Number in case of ?s

</font>


    </td>
    <td><input type="text" name="field_287" style="width:100%">
    
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<input type="hidden" name="name_288" value="Design Name/Number">
<tr>
    <td><img src="widgets/gen_378.1.gif" border="0" align="absmiddle">


<font face='Arial' size='2' color='#000000'>

Design Name/Number

</font>


    </td>
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<input type="hidden" name="name_289" value="Quantity (minimum 25) or Digital File">
<tr>
    <td><img src="widgets/gen_378.1.gif" border="0" align="absmiddle">


<font face='Arial' size='2' color='#000000'>

Quantity (minimum 25) or Digital File

</font>


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<input type="hidden" name="name_290" value="Size 4 x 6 or 5 x 7">
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<font face='Arial' size='2' color='#000000'>

Size 4 x 6 or 5 x 7

</font>


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<input type="hidden" name="name_291" value="Event Type">
<tr>
    <td><img src="widgets/gen_378.1.gif" border="0" align="absmiddle">


<font face='Arial' size='2' color='#000000'>

Event Type

</font>


    </td>
    <td><input type="text" name="field_291" style="width:100%">
    
    </td>
<input type="hidden" name="name_292" value="Event Location and Time">
<tr>
    <td><img src="widgets/gen_378.1.gif" border="0" align="absmiddle">


<font face='Arial' size='2' color='#000000'>

Event Location and Time

</font>


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<input type="hidden" name="name_293" value="RSVP">
<tr>
    <td><img src="widgets/gen_378.1.gif" border="0" align="absmiddle">


<font face='Arial' size='2' color='#000000'>

RSVP

</font>


    </td>
    <td><input type="text" name="field_293" style="width:100%">
    
    </td>
<input type="hidden" name="name_294" value="Bridal or Baby Registry Info">
<tr>
    <td><img src="widgets/gen_378.1.gif" border="0" align="absmiddle">


<font face='Arial' size='2' color='#000000'>

Bridal or Baby Registry Info

</font>


    </td>
    <td><textarea name="field_294" rows="5" cols="30"></textarea>
    
    </td>
<input type="hidden" name="name_295" value="Do you want the photo to be color or black and white? We also offer color selection (black and white with one color popped) ">
<tr>
    <td><img src="widgets/gen_378.1.gif" border="0" align="absmiddle">


<font face='Arial' size='2' color='#000000'>

Do you want the photo to be color or black and white? We also offer color selection (black and white with one color popped) 

</font>


    </td>
    <td><input type="text" name="field_295" style="width:100%">
    
    </td>
<input type="hidden" name="name_296" value="Please describe in detail any small changes that you would like made to your design? (Example: I would like a pink heart instead of the word love) ">
<tr>
    <td><img src="widgets/gen_378.1.gif" border="0" align="absmiddle">


<font face='Arial' size='2' color='#000000'>

Please describe in detail any small changes that you would like made to your design? (Example: I would like a pink heart instead of the word love) 

</font>


    </td>
    <td><textarea name="field_296" rows="5" cols="30"></textarea>
    
    </td>
<input type="hidden" name="name_297" value="How did you hear about us? ">
<tr>
    <td><img src="widgets/gen_378.1.gif" border="0" align="absmiddle">


<font face='Arial' size='2' color='#000000'>

How did you hear about us? 

</font>


    </td>
    <td><input type="text" name="field_297" style="width:100%">
    
    </td>
<input type="hidden" name="name_298" value="Promo Code ">
<tr>
    <td><img src="widgets/gen_378.1.gif" border="0" align="absmiddle">


<font face='Arial' size='2' color='#000000'>

Promo Code 

</font>


    </td>
    <td><input type="text" name="field_298" style="width:100%">
    
    </td>
<input type="hidden" name="name_299" value="Would you like to be added to our Newsletter? It comes out a few times a year with new product information, sales and savings?">
<tr>
    <td><img src="widgets/gen_378.1.gif" border="0" align="absmiddle">


<font face='Arial' size='2' color='#000000'>

Would you like to be added to our Newsletter? It comes out a few times a year with new product information, sales and savings?

</font>


    </td>
    <td><input type="radio" name="field_299" value="Yes">


<font face='Arial' size='2' color='#000000'>

Yes

</font>


<input type="radio" name="field_299" value="No">


<font face='Arial' size='2' color='#000000'>

No

</font>


    </td>

</tr>
<tr><td align=center colspan=2>
    <input onClick="return validate(form)" type="submit" value="Submit">
    <input type="reset"  value="Reset">
    </td>
</tr>
</table>
</center>
</form>

                </td>
                <td background="widgets/gen_81.1.gif" width="15">
                        <img src="widgets/spacer.gif" width="15" height="1"></td>
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                        <img src="widgets/spacer.gif" width="20" height="1"></td>
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                <td background="widgets/gen_80.1.gif">
                        <img src="widgets/gen_82.1.gif" width="15" height="14"></td>
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                        <img src="widgets/gen_80.1.gif" width="100" height="14" border="0"></td>
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                        <img src="widgets/gen_83.1.gif" width="15" height="14"></td>
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</table>

<!-- EOF: ./personal-templates/simple/businessnew/form/style_l14.html -->

                <br>
                        

<br>
<FONT FACE="verdana, arial, helvetica" SIZE="1">
<center>
<nobr>|<a href="index.html">Home</A>|</nobr>

<nobr>|<a href="custom-photo-card-design-process.html">The Process</A>|</nobr>

<nobr>|<a href="custom-photo-card-designs.html">Photo Cards</A>|</nobr>

<nobr>|<a href="gpage6.html">Stickers</A>|</nobr>

<nobr>|<a href="personalized-stationery.html">Stationery</A>|</nobr>

<nobr>|<a href="custom-photo-candy-bar-wrappers.html">Wrappers</A>|</nobr>

<nobr>|<a href="faq.html">FAQ</A>|</nobr>

<nobr>|<a href="Order.html">Order</A>|</nobr>

<nobr>|<a href="kudos.html">Kudos</A>|</nobr>

<nobr>|<a href="About Us.html">About Us</A>|</nobr>

<nobr>|<a href="form.html">Free Sample</A>|</nobr>

<nobr>|<a href="external.html">Blog</A>|</nobr>

<nobr>|<a href="gpage5.html">Contact Us</A>|</nobr>
</center>
</font>

<br>
                        
<center><table border="0" cellpadding="0" cellspacing="3"><tr><td align="center">

<a href="http://www.psoft.net" target="_blank"><img src="widgets/ss_button.gif" border="0"></a>

<br>
<font face="helvetica,verdana, arial" size="1">Copyright ©  2001-2008 - Polka Dot Bumblee™. - All Rights Reserved <P>  The entire content of this website including but not limited to our designs, artwork, logos and text is protected under all United States and International Copyright Laws.  </font>

</td></tr></table></center>

                </TD>
        </TR>
        </TABLE>

                </TD>
                <TD WIDTH=115 HEIGHT=368 VALIGN="top" BACKGROUND="widgets/gen_44.1.gif">
                        <TABLE WIDTH=115 HEIGHT=368 BORDER=0 CELLPADDING=0 CELLSPACING=0 BACKGROUND="widgets/gen_45.1.gif">
                        <TR>
                                <TD VALIGN="top" HEIGHT=368>
                                        <IMG SRC="widgets/spacer.gif" WIDTH=103 HEIGHT=15 border="0"><br>
                                        <a href="index.html" onMouseOver="document.images['img8'].src='widgets/gen_1574.1.gif'" onMouseOut="document.images['img8'].src='widgets/gen_1575.1.gif'"><img src="widgets/gen_1575.1.gif" alt="Home" name="img8" border="0"></a><br><a href="custom-photo-card-design-process.html" onMouseOver="document.images['img12'].src='widgets/gen_325.1.gif'" onMouseOut="document.images['img12'].src='widgets/gen_326.1.gif'"><img src="widgets/gen_326.1.gif" alt="The Process" name="img12" border="0"></a><br><a href="custom-photo-card-designs.html" onMouseOver="document.images['img21'].src='widgets/gen_1597.1.gif'" onMouseOut="document.images['img21'].src='widgets/gen_1598.1.gif'"><img src="widgets/gen_1598.1.gif" alt="Photo Cards" name="img21" border="0"></a><br><a href="gpage6.html" onMouseOver="document.images['img366'].src='widgets/gen_1734.1.gif'" onMouseOut="document.images['img366'].src='widgets/gen_1735.1.gif'"><img src="widgets/gen_1735.1.gif" alt="Stickers" name="img366" border="0"></a><br><a href="personalized-stationery.html" onMouseOver="document.images['img318'].src='widgets/gen_1594.1.gif'" onMouseOut="document.images['img318'].src='widgets/gen_1595.1.gif'"><img src="widgets/gen_1595.1.gif" alt="Stationery" name="img318" border="0"></a><br><a href="custom-photo-candy-bar-wrappers.html" onMouseOver="document.images['img333'].src='widgets/gen_1713.1.gif'" onMouseOut="document.images['img333'].src='widgets/gen_1714.1.gif'"><img src="widgets/gen_1714.1.gif" alt="Wrappers" name="img333" border="0"></a><br><a href="faq.html" onMouseOver="document.images['img34'].src='widgets/gen_382.1.gif'" onMouseOut="document.images['img34'].src='widgets/gen_383.1.gif'"><img src="widgets/gen_383.1.gif" alt="FAQ" name="img34" border="0"></a><br><a href="Order.html" onMouseOver="document.images['img165'].src='widgets/gen_1551.1.gif'" onMouseOut="document.images['img165'].src='widgets/gen_1552.1.gif'"><img src="widgets/gen_1552.1.gif" alt="Order" name="img165" border="0"></a><br><a href="kudos.html" onMouseOver="document.images['img48'].src='widgets/gen_388.1.gif'" onMouseOut="document.images['img48'].src='widgets/gen_389.1.gif'"><img src="widgets/gen_389.1.gif" alt="Kudos" name="img48" border="0"></a><br><a href="About Us.html" onMouseOver="document.images['img86'].src='widgets/gen_410.1.gif'" onMouseOut="document.images['img86'].src='widgets/gen_411.1.gif'"><img src="widgets/gen_411.1.gif" alt="About Us" name="img86" border="0"></a><br><a href="form.html" onMouseOver="document.images['img119'].src='widgets/gen_1553.1.gif'" onMouseOut="document.images['img119'].src='widgets/gen_1554.1.gif'"><img src="widgets/gen_1554.1.gif" alt="Free Sample" name="img119" border="0"></a><br><a href="external.html" onMouseOver="document.images['img173'].src='widgets/gen_1544.1.gif'" onMouseOut="document.images['img173'].src='widgets/gen_1545.1.gif'"><img src="widgets/gen_1545.1.gif" alt="Blog" name="img173" border="0"></a><br><a href="gpage5.html" onMouseOver="document.images['img219'].src='widgets/gen_1579.1.gif'" onMouseOut="document.images['img219'].src='widgets/gen_1580.1.gif'"><img src="widgets/gen_1580.1.gif" alt="Contact Us" name="img219" border="0"></a><br>
                                </TD>
                        </TR>
                        </TABLE>
                        <img src="widgets/gen_46.1.gif" height="92" width="103">
                </TD>
        </TR>
        <TR>
                <TD WIDTH=100% HEIGHT=44 BGCOLOR=#FFFFFF VALIGN="top" BACKGROUND="widgets/gen_48.1.gif">
                        <IMG SRC="widgets/gen_49.1.gif" WIDTH=169 HEIGHT=44></TD>
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                        <IMG SRC="widgets/gen_47.1.gif" WIDTH=115 HEIGHT=44></TD>
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</TABLE>

<!-- EOF: ./personal-templates/simple/businessnew/layout/l14.layout -->

    
<!-- BOF: ./personal-templates/simple/themes.show.body -->


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</body>
<!-- BOF: ./personal-templates/simple/themes.show.end -->


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</html>


<!-- EOF: ./personal-templates/show.body -->