https://meribah-ram-pump.com/contact/

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64        <div class="mod_headerLogo">
65          <a href="/"><img src="/water-logo.jpg" width="268" height="273" alt="Meribah Ram Pump"></a>
66        </div>
67        <div class="mod_headerImage"><img src="/tl_files/fM_k0002/images/header_img.jpg" width="634" height="269" alt="Meribah Ram Pump - proved and reliable waterpump solutions"></div>
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71            <li class="sibling first"><a href="/" title="Home" class="sibling first">Home</a></li>
72            <li class="sibling"><a href="/service" title="Service & Products" class="sibling">Service/Products</a></li>
73            <li class="sibling"><a href="/success-stories" title="Success Stories" class="sibling">Success Stories</a></li>
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76            <li class="sibling"><a href="/about-us" title="About Us" class="sibling">About Us</a></li>
77            <li class="active last"><span class="active last">Contact</span></li>
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86          <div class="mod_newslist block" id="breaking_news">
87            <h1>Latest Information</h1>
88            <div class="layout_short block first even">
89              <p class="info">2015-02-25 02:35</p>
90              <h2><a href="/pump" title="Read the article: Papa Ram Pump - NOW AVAILABLE">Papa Ram Pump - NOW AVAILABLE</a></h2>
91              <div class="teaser">
92                <p>Now we are able to provide our extended products line with the Papa Ram Pump.</p>
93                <p><img src="/system/html/Papa%20Ram-511fa1e6.jpg" width="200" height="114" alt=""></p>
94              </div>
95              <p class="more"><a href="/pump" title="Read the article: Papa Ram Pump - NOW AVAILABLE">Read more … <span class="invisible">Papa Ram Pump - NOW AVAILABLE</span></a></p>
96            </div>
97            <div class="layout_short block last odd">
98              <p class="info">2012-04-27 03:03</p>
99              <h2><a href="/hua-doi" title="Read the article: Hua Doi (Thailand)">Hua Doi (Thailand)</a></h2>
100              <div class="teaser">
101                <p>The last installation was in a remote village in the Mae Hong Son province.</p>
102                <p><img src="/system/html/2012-04%20Hua%20Doi%20Thailand%20Meribah%20Ram%20Pump%202%20inch%20Raintree%20Foundation.JPG-85255ff2.jpg" width="200" height="150" alt=""></p>
103              </div>
104              <p class="more"><a href="/hua-doi" title="Read the article: Hua Doi (Thailand)">Read more … <span class="invisible">Hua Doi (Thailand)</span></a></p>
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109            <div class="image_container"><img src="/system/html/ram%20pump%20test%20air%20chamber%20pressure%20vessel-985344b3.jpg" width="280" height="421" alt="ram pump test air chamber pressure vessel"></div>
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117              <h1>Contact Us</h1>
118              <form action="index.php?id=36" id="f3" method="post" enctype="application/x-www-form-urlencoded" name="f3">
119                <div class="formbody">
120                  <input type="hidden" name="FORM_SUBMIT" value="auto_form_3"><input type="hidden" name="REQUEST_TOKEN" value="b674379dc5e183d0da6922e9c9a76847"><input type="hidden" name="MAX_FILE_SIZE" value="2048000">
121                  <div class="row_0 row_first even headline">
122                    <p>

122Please fill out all relevant fields.<br>
123                    Our staff will then be able to provide all the information you might need.<br>
124                    <br></p>
125                  </div>
126<label for="ctrl_13" class="mandatory"><span class="invisible">Mandatory field</span> Your Name/Company<span class="mandatory">*</span></label> <input type="text" name="name" id="ctrl_13" class="text mandatory" value="" maxlength="350" tabindex="25"><br>
127                  <label for="ctrl_15" class="mandatory"><span class="invisible">Mandatory field</span> Valid email adress<span class="mandatory">*</span></label> <input type="text" name="email" id="ctrl_15" class="text mandatory" value="" maxlength="350" tabindex="25"><br>
128                  <label for="ctrl_36" class="mandatory"><span class="invisible">Mandatory field</span> Your country<span class="mandatory">*</span></label> <input type="text" name="country" id="ctrl_36" class="text mandatory" value="" maxlength="350" tabindex="25"><br>
129                  <label for="ctrl_14">Your phone number</label> <input type="text" name="telephone" id="ctrl_14" class="text" value="" maxlength="350" tabindex="25"><br>
130                  <fieldset id="ctrl_19" class="checkbox_container mandatory">
131                    <legend>
132<span class="invisible">Mandatory field</span> Your Inquiry For:<span class="mandatory">*</span>
133</legend>
134<input type="hidden" name="inquiry" value=""><span><input type="checkbox" name="inquiry[]" id="opt_19_0" class="checkbox" value="information"><label id="lbl_19_0" for="opt_19_0">more information</label></span><span><input type="checkbox" name="inquiry[]" id="opt_19_1" class="checkbox" value="price"><label id="lbl_19_1" for="opt_19_1">the price and product list</label></span><span><input type="checkbox" name="inquiry[]" id="opt_19_2" class="checkbox" value="order"><label id="lbl_19_2" for="opt_19_2">order a ram pump</label></span><span><input type="checkbox" name="inquiry[]" id="opt_19_3" class="checkbox" value="survey"><label id="lbl_19_3" for="opt_19_3">a site survey</label></span><span><input type="checkbox" name="inquiry[]" id="opt_19_4" class="checkbox" value="installation"><label id="lbl_19_4" for="opt_19_4">a ram installation</label></span><span><input type="checkbox" name="inquiry[]" id="opt_19_5" class="checkbox" value="phonecall"><label id="lbl_19_5" for="opt_19_5">

134a phone call</label></span><span><input type="checkbox" name="inquiry[]" id="opt_19_6" class="checkbox" value="others"><label id="lbl_19_6" for="opt_19_6">others</label></span><span><input type="checkbox" name="inquiry[]" id="opt_19_7" class="checkbox" value="donate"><label id="lbl_19_7" for="opt_19_7">a donation for a entire water supply system</label></span>
135                  </fieldset>
136<br>
137                  <div class="row_6 even explanation">
138                    <p><span style="color: #0000ff; font-size: 12px;">Site Survey Data:</span></p>
139                  </div>
140                  <div class="row_7 odd explanation">
141                    <p> </p>
142                    <p style="margin-bottom: 0in;"><strong>Water amount</strong> of the <strong>available water source</strong> in liters per minute:</p>
143                  </div>
144<label for="ctrl_21">Water from the source</label> <input type="text" name="amountwatersource" id="ctrl_21" class="text" value="" tabindex="10"><br>
145                  <div class="row_9 odd explanation">
146                    <p> </p>
147                    <p>Possible <strong>height difference</strong> between <strong>water source</strong> and <strong>ram pump</strong> in meters:</p>
148                  </div>
149<label for="ctrl_22">Head</label> <input type="text" name="heightdifference" id="ctrl_22" class="text" value=""><br>
150                  <div class="row_11 odd explanation">
151                    <p> </p>
152                    <p>Estimated <strong>distance</strong> between <strong>water source</strong> and <strong>ram pump</strong> in meters:</p>
153                  </div>
154<label for="ctrl_23">Drive Pipe Length</label> <input type="text" name="estimateddistance" id="ctrl_23" class="text" value=""><br>
155                  <div class="row_13 odd explanation">
156                    <p> </p>
157                    <p><strong>Height difference</strong> between <strong>ram pump</strong> and <strong>point of delivery</strong> in meters:</p>
158                  </div>
159<label for="ctrl_24">Delivery Height</label> <input type="text" name="heightdifference" id="ctrl_24" class="text" value=""><br>
160                  <div class="row_15 odd explanation">
161                    <p> </p>
162                    <p><strong>Distance</strong> between <strong>ram pump</strong> and <strong>point of delivery</strong> in meters:</p>
163                  </div>
164<label for="ctrl_25">Delivery Pipe Length</label> <input type="text" name="distancetodeliverypoint" id="ctrl_25" class="text" value=""><br>
165                  <div class="row_17 odd explanation">
166                    <p> </p>
167                    <p><strong>Needed delivery amount</strong> in liters per day:</p>
168                  </div>
169<label for="ctrl_26">Needed output</label> <input type="text" name="deliveryamountperday" id="ctrl_26" class="text" value=""><br>
170                  <div class="row_19 odd explanation">
171                    <p> </p>
172                    <p>Comments:</p>
173                  </div>
174                  <textarea name="comment" id="ctrl_17" class="textarea" rows="20" cols="45" tabindex="50"></textarea><br>
175                  <div class="row_21 odd explanation">
176                    <p><br>
177                    <strong>To prevent automated submissions, please answer the security question<br>
178                    <br></strong></p>
179                  </div>
180<input type="text" name="c3959cb0a8b6c3a1cf95b0329f37db21d" id="ctrl_48" class="captcha mandatory" value="" maxlength="2"><span class="captcha_text">What is the sum of 8 and 9?</span><br>
181                  <br>
182                  <br>
183                  <div class="submit_container">
184                    <input type="submit" id="ctrl_18" class="submit" value="Submit Form">
185                  </div>
186                </div>
187              </form>
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197          <a href="/" title="Meribah Ram Pump">Meribah Ram Pump</a> > <span class="active">Contact</span>
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199        <div class="copyright">
200          Copyright © 2008 - 2016 Meribah Ram Pump | all rights reserved | Created by Human Hosting
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