Send A Referral

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<style type="text/css"><!--
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--></style>
<style type="text/css"><!--
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--></style>
<style type="text/css"><!--
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.infusion-field-input-container {
width:200px;
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.infusion-field-label-container {
vertical-align:Middle;
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.bodyContainer {
width:465px;
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--></style>
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<script src="https://mv972.infusionsoft.com/resources/external/recaptcha/production/recaptcha.js?b=1.70.0.136153" type="text/javascript">// <![CDATA[

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<div class="text" id="webformErrors" name="errorContent"></div>
<form accept-charset="UTF-8" action="https://mv972.infusionsoft.com/app/form/process/94f3dc7ebe6c28aceae2cc2c6dd510f9" class="infusion-form" id="inf_form_94f3dc7ebe6c28aceae2cc2c6dd510f9" method="POST" name="FDS Referral Form" onsubmit="submitWebForm()">
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<div class="custom-35 beta-base beta-font-b" id="mainContent" style="height: 100%;">
<table cellpadding="10" cellspacing="0" class="background" style="width: 100%; height: 100%;">
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<td class="body" sectionid="body" valign="top" style="background-color: #ffffff;">
<div>
<div class="authoring-image image-snippet" contentid="image">
<div class="authoring-image image-snippet" contentid="image">
<div class="imageSnippet-alignDiv" style="text-align: center;"><img align="bottom" alt="Interesting Image" class="simage float_center" src="https://d1yoaun8syyxxt.cloudfront.net/mv972-a6be0112-021d-4d8f-8ec3-87959cbc1da8-v2" style="margin-left: 0px; margin-right: 0px; border-width: 0px; border-style: solid; vertical-align: text-bottom;" title="Interesting Image" width="1148" height="225" /></div>
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<div>
<div class="text">
<div class="text" contentid="paragraph">
<div style="text-align: center;"></div>
<div style="text-align: center;"><span style="font-size: 18pt; font-family: arial, helvetica, sans-serif;"><strong><span style="font-size: 18pt; font-family: arial, helvetica, sans-serif; color: #cc6699;"></span></strong></span></div>
<div style="text-align: center;"><span style="font-size: 18pt; font-family: arial, helvetica, sans-serif;"><strong><span style="font-size: 18pt; font-family: arial, helvetica, sans-serif; color: #cc6699;"></span></strong></span></div>
<div style="text-align: center;"><span style="font-size: 18pt; font-family: arial, helvetica, sans-serif;"><strong><span style="font-size: 18pt; font-family: arial, helvetica, sans-serif; color: #cc6699;"></span></strong></span></div>
<div style="text-align: center;"></div>
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<div class="text">
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<div style="text-align: center;"><span style="font-family: verdana, sans-serif; color: #000000;"></span></div>
<div style="text-align: center;"><span style="font-family: verdana, sans-serif; color: #000000;"></span></div>
<div style="text-align: center;"><span style="font-family: verdana, sans-serif; color: #000000;"></span></div>
<h3 style="text-align: center;"><span style="font-family: verdana, sans-serif; color: #000000;">Refer a friend, and both of you can receive a 10% off coupon. If your friend goes to our site from the email we send them, you will both be sent a 10% off coupon.</span></h3>
<div style="text-align: center;"><span style="font-family: verdana, sans-serif; color: #000000;"></span></div>
<div style="text-align: center;"><span style="font-family: verdana, sans-serif; color: #000000;"></span></div>
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<div>
<table class="infusion-field-container" style="width: 100%;">
<tbody>
<tr>
<td class="infusion-field-label-container"><label for="inf_field_FirstName">Your First Name *</label></td>
<td class="infusion-field-input-container" style="width: 200px;"><input class="infusion-field-input" id="inf_field_FirstName" name="inf_field_FirstName" placeholder="Your First Name *" type="text" /></td>
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<div>
<table class="infusion-field-container" style="width: 100%;">
<tbody>
<tr>
<td class="infusion-field-label-container"><label for="inf_field_Email">Your Email *</label></td>
<td class="infusion-field-input-container" style="width: 200px;"><input class="infusion-field-input" id="inf_field_Email" name="inf_field_Email" placeholder="Your Email *" type="text" /></td>
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<div>
<div style="height: 20px;">
<div style="height: 10px; border-bottom: 1px solid #cccccc;"> </div>
<div style="height: 10px;"> </div>
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</div>
<div>
<table class="infusion-field-container" style="width: 100%;">
<tbody>
<tr>
<td class="infusion-field-label-container"><label for="inf_custom_ReferralName">Referral First Name *</label></td>
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<div>
<table class="infusion-field-container" style="width: 100%;">
<tbody>
<tr>
<td class="infusion-field-label-container"><label for="inf_field_EmailAddress2">Referral Email *</label></td>
<td class="infusion-field-input-container" style="width: 200px;"><input class="infusion-field-input" id="inf_field_EmailAddress2" name="inf_field_EmailAddress2" placeholder="Referral Email *" type="text" /></td>
</tr>
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<div>
<table class="infusion-field-container" style="width: 100%;">
<tbody>
<tr>
<td class="infusion-field-label-container"><label class="infusion-field-label-container" for="inf_option_WhatAreTheyInterestedIn">What Are They Interested In? *</label></td>
<td class="infusion-field-input-container" style="width: 200px;">
<div class="infusion-radio">
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</td>
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<div>
<div style="height: 15px; line-height: 15px;"> </div>
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<div>
<div class="infusion-submit" style="text-align: left;"><button class="infusion-recaptcha" id="recaptcha_94f3dc7ebe6c28aceae2cc2c6dd510f9" type="submit" value="Submit Referral!">Submit Referral!</button></div>
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</td>
</tr>
</tbody>
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</td>
</tr>
</tbody>
</table>
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</form>
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