print $page_title ?>
CoreComm is happy to answer any questions you might have about our company, our services, or our website. Please complete the fields below to enable us to better meet your needs.
Nature of inquiry
if(isset($name_error)){ print '
'; } ?>
Name
(required)
if(isset($name_error)){ print ''; } ?>
if(isset($email_error)){ print '
'; } ?>
Complete E-Mail address
(required)
if(isset($email_error)){ print ''; } ?>
Mailing Address
City
State
Zip Code
$states = array("AK", "AL", "AR", "AZ", "CA", "CO", "CT", "DC", "DE", "FL", "GA", "HI", "IA", "ID", "IL", "IN", "KS", "KY", "LA", "M A", "MD", "ME", "MI", "MN", "MO", "MS", "MT", "NC", "ND", "NE", "NH", "NJ", "NM", "NV", "NY", "OH", "OK", "OR", "PA", "RI", "SC", "S D", "TN", "TX", "UT", "VA", "VT", "WA", "WI", "WV", "WY"); if (empty($_REQUEST['state'])){ echo '
--
\n'; } else { echo '
--
\n'; } foreach ($states as $value){ if ($_REQUEST['state'] == $value){ echo "
$value
\n"; } else { echo "
$value
\n"; } } ?>
if ($_REQUEST['link'] != 'sales') { ?>
CoreComm Phone Number
}else { ?>
Phone Number
} ?> if ($_REQUEST['careform'] == 1){ ?>
Alternate Phone Number
} ?>
if ($_REQUEST['careform'] == 1){ ?>
} ?>
Comments/Message: