Victa Technologies AHCN Towers, Suite 206, Alausa, Ikeja, Nigeria. Tel: +234 708 058 5573, +234 803 303 2288 Email: info@victatech.com.ng
View Larger Map</a></small></p></td> </tr> <tr> <td align="left" id="det">Fields marked <span id="red">*</span> are mandatory and must be filled in before sending the form.</td> </tr> <tr> <td align="left" id="det2"><table width="100%" align="center"> <tr> <td colspan="2" align="center" valign="middle" bgcolor="#FFFFFF"><form id="form1" name="form1" method="POST" action=""> <table width="90%" align="center" id="det"> <tr> <td width="18%" height="29" align="left" valign="middle">NAME: <span id="red"><strong>*</strong></span></td> <td colspan="2" align="left" valign="middle"><label for="name"></label> <input name="name" type="text" id="name" size="65" /></td> </tr> <tr> <td height="31" align="left" valign="middle">COMPANY:</td> <td colspan="2" align="left" valign="middle"><label for="company"></label> <input name="company" type="text" id="company" size="65" /></td> </tr> <tr> <td height="31" align="left" valign="middle">E-MAIL: <span id="red"><strong>*</strong></span></td> <td colspan="2" align="left" valign="middle"><label for="email"></label> <input name="email" type="text" id="email" size="65" /></td> </tr> <tr> <td height="41" align="left" valign="middle">TELEPHONE: <span id="red"><strong>*</strong></span></td> <td colspan="2" align="left" valign="middle"><input name="telephone" type="text" id="telephone" size="65" /></td> </tr> <tr> <td height="68" align="left" valign="middle">COMMENT: </td> <td width="57%" align="left" valign="middle"><label for="comment"></label> <textarea name="comment" id="comment" cols="55" rows="4"></textarea> <label for="telephone"></label></td> <td width="25%" align="center" valign="bottom"><input type="submit" name="button" id="button" class="button1" value="Submit" /></td> </tr> <tr> <td> </td> <td colspan="2"> </td> </tr> </table> <br /> <input type="hidden" name="MM_insert" value="form1" /> </form></td> </tr> </table></td> </tr> </table></td> </tr> </table></td> </tr> <tr> <td align="center" valign="middle"><br /> <table width="1100" align="center"> <tr> <td width="435" id="h1"> © COPYRIGHTS VICTATECH NIG. 2013 </td> <td width="132" align="center" valign="top" id="syd"><a href="index.php">HOME</a></td> <td width="135" align="center" valign="top" id="syd"><a href="news.php">NEWS</a></td> <td width="204" align="center" valign="top" id="syd"><a href="terms.php">TERMS & CONDITIONS</a></td> <td width="170" align="center" valign="top" id="syd"><a href="contactus.php">CONTACT US</a></td> </tr> </table> <br /></td> </tr> </table> <br /> </body> </html>
