<HTML>
<HEAD>
<TITLE>The Quarterdeck Inn on Long Beach Island ~~ Information Request </TITLE>
</HEAD>
<BODY BGCOLOR="#FFFFF0" TEXT="#005500" LINK="#0000FF" ALINK="#FF0000" VLINK="#800080">
<B>
<CENTER>

<FONT SIZE="+2">The Quarterdeck Inn<BR>First on Long Beach Island</FONT>
<P>
For more information<BR>
<FONT SIZE=+1>Please supply this contact information:<BR>
    </FONT>
<P>
<FORM ACTION="http://www.ilovelbi.com/cgi-bin/inn-info.pl" METHOD="POST">
<INPUT TYPE=HIDDEN NAME="TITLE" VALUE="The Quarterdeck Inn">
<INPUT TYPE=HIDDEN NAME="HOME-PAGE" VALUE="/quarterdeck/index.html">
<INPUT TYPE=HIDDEN NAME="RECIPIENT" VALUE="quarterdeck@ilovelbi.com">

<INPUT TYPE=HIDDEN NAME="SUBJECT" VALUE="Information Request">
<INPUT TYPE=HIDDEN NAME="required" VALUE="realname,address,city,state,zip,heard_about_you_from">
<INPUT TYPE=HIDDEN NAME="redirect" VALUE="http://www.queenvictoria.com/thanks/inforequest.html">


<TABLE BORDER=0 CELLPADDING=0 WIDTH=450>
  <TR><TD COLSPAN="2"><B> Supplied information is for the exclusive use of
	 The Quarterdeck Inn. Your information will not be given or sold to
	 any third parties.</B><P></TD></TR>
  <TR><TD ALIGN="right"><B>Name:</TD>
      <TD><INPUT TYPE=TEXT NAME="NAME" SIZE="25" MAXLENGTH="50"></B></TD>
  </TR>
  <TR><TD ALIGN="right"><B>Address:</TD>
      <TD><INPUT TYPE=TEXT NAME="ADDRESS" SIZE="25" MAXLENGTH="50"></B></TD>
  </TR>
      <TR><TD ALIGN="right"><B>Apt. #:</TD>
      <TD><INPUT TYPE=TEXT NAME="APT" SIZE="25" MAXLENGTH="50"></B></TD>
  </TR>
  <TR><TD ALIGN="right"><B>City:</TD>
      <TD><INPUT TYPE=TEXT NAME="CITY" SIZE="25" MAXLENGTH="50"></B></TD>
  </TR>
  <TR><TD ALIGN="right"><B>State:</TD>
      <TD><INPUT TYPE=TEXT NAME="STATE" SIZE="2" MAXLENGTH="15">
	       Zip: <INPUT TYPE=TEXT NAME="ZIP" SIZE="10" MAXLENGTH="15"></B></TD>
  </TR>
  <TR><TD ALIGN="right"><B>Phone:</TD>
      <TD><INPUT TYPE=TEXT NAME="PHONE" SIZE="25" MAXLENGTH="50"></B></TD>
  </TR>
  <TR><TD ALIGN="right"><B>Best time to call:</TD>
      <TD><INPUT TYPE=TEXT NAME="BEST-TIME" SIZE="25" MAXLENGTH="50"></B></TD>
  </TR>
  <TR><TD ALIGN="right"><B>E-Mail Address:</TD>
      <TD><INPUT TYPE=TEXT NAME="EMAIL" SIZE="25" MAXLENGTH="50"><P></B></TD>
  </TR>
  <TR><TD ALIGN="CENTER" COLSPAN="2"><B><FONT SIZE="+2">DATE RANGE OF INTEREST:</FONT></B></TD>
  </TR>
  <TR><TD ALIGN="CENTER" COLSPAN="2"><B>From:
      <INPUT TYPE=TEXT NAME="FROM-DATE" SIZE="15" MAXLENGTH="50">
      &nbsp; &nbsp; To: <INPUT TYPE=TEXT NAME="TO-DATE" SIZE="15" MAXLENGTH="50"></B></TD>
	  	  
  </TR>  
  <TR><TD ALIGN="CENTER" COLSPAN="2">
       <B>Number in party:</B>
      <SELECT NAME="ADULTS">
         <OPTION VALUE="2">2
         <OPTION VALUE="1">1
         <OPTION VALUE="3">3
         <OPTION VALUE="4">4
 	 </SELECT><P></TD>
  </TR>
  <TR><TD COLSPAN="2" ALIGN="CENTER"><P>
   <B>Use the space below for additional information or questons:</B><BR>
   <TEXTAREA  NAME="INFO"  ROWS="5" WRAP="PHYSICAL" COLS="40" ></TEXTAREA></TD>
  </TR>
  <TR><TD COLSPAN="2" ALIGN="CENTER">
     <INPUT TYPE="IMAGE" BORDER="0" SRC="graphics/submit.gif"><P></TD>
   </TR>
   <TR><TD COLSPAN="2"><B>NOTE: This is a request for information only. Completion of this
        form does not reserve a room or represent a commitment from either party.</B></TD></TR>
   </TABLE>
</FORM>
</CENTER>
<CENTER>
<B>
<IMG SRC="graphics/blue-bar.gif" WIDTH=398 HEIGHT=8 BORDER=0 ALT="Blue Bar">
<P>
<FONT COLOR="Green" SIZE="+0" FACE="Courier New">
On the Causeway to Long Beach Island<BR>
351 West 9th Street<BR>
Ship Bottom, NJ 08008</FONT>
<P>
<FONT COLOR="Green" SIZE="-1" FACE="Courier New">
(609) 494-9055 or (609) 494-3334<BR>
E-Mail us at <A HREF="mailto:quaterdeck@ilovelbi.com">QuarterDeck@ILoveLBI.com</A></FONT>
<P>
</CENTER>

	 </BODY>
</HTML>