Comments

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" height=100 style=" border-bottom: 1px solid #CCCCCC;" BGCOLOR="#C0C0C0" TEXT="#080000" bgproperties="fixed" background="3d77b6e1excwnc.jpg"> <div> <B><IMG SRC="3d5e1580.jpg" border=0 width="225" height="88" ALIGN="LEFT" HSPACE="0" VSPACE="0"></B></div> <bR> <div> <A HREF="index.htm" TARGET="_top" TITLE="DentalSource"><B><U>Home</U></B></A></div> </td> </tr><tr> <td valign="top" height=340 BGCOLOR="#EEEEEE" TEXT="#080000"> <div> Comments</div> <bR> <div> DentalSource Appreciates your Comments and Concerns.</div> <div> Please feel free to comment on our website or services below.</div> <div>  <form action="http://csbmail.globalscape.com/cgi-bin/csbmail/csbmail.pl" method="POST" enctype="application/x-www-form-urlencoded"><input type="hidden" name="tlx_SortOrder" value="name,email,city,state,zip,comments"><input type="hidden" name="tlx_FormIndex" value="1"><input type="hidden" name="tlx_OKMessage" value="We appreciate your feedback and will respond to any questions or concerns you may have by the end of the next business day."><input type="hidden" name="tlx_SendMode" value="1"><input type="hidden" name="tlx_Subject" value="A comment form was submitted"><input type="hidden" name="tlx_EmailTo" value="online@dentalsourcenm.com"> <table cellpadding="5" cellspacing="1" border="0" align="center"> <tr> <td align="left">Name: <br> <input type="text" name="name" size="30" maxlength="100"> </td> </tr> <tr> <td align="left">Email: <br> <input type="text" name="email" size="30" maxlength="100"> </td> </tr> <tr> <td align="left">City: <br> <input type="text" name="city" size="30" maxlength="100"> </td> </tr> <tr> <td align="left">State: <br> <input type="text" name="state" size="30" maxlength="100"> </td> </tr> <tr> <td align="left">Zip: <br> <input type="text" name="zip" size="10" maxlength="10"> </td> </tr> <tr> <td align="left">Comments: <br> <textarea name="comments" rows="5" cols="30"></textarea> </td> </tr> <tr> <td align="right"> <input type="reset"> <input type="submit" value="Send" name="tlx_send"> </td> </tr> </table> </form>  </div> </td> </tr><tr> <td valign="top" height=39 style=" border-top: 1px solid #CCCCCC;" BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" WIDTH="7"><B>     </B><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" WIDTH="7"><B>        </B><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" WIDTH="14"><B>   </B><IMG BORDER="0" SRC="1x1.gif" HEIGHT="14" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" WIDTH="14"></div> <bR> </td> </tr></table></body>