document.write('<script type=\"text/javascript\" src=\"https://assets.bravenet.com/bn/js/emailfwd/bn_email_forms.min.js\"></script><link rel=\"stylesheet\" href=\"https://pub50.bravenet.com/emailfwd/v2/bnet-form.css.php?usernum=4277634906&formid=3819&formpadding=0\"><form method=\"post\" class=\"bnet-form\" enctype=\"multipart/form-data\" action=\"#bn-ajax-post:4277634906:50:3819\"><div class=\"bn-form-header\"><div class=\"bn-form-legend\"><div>Advance Auto Parts - Drum Order Form</div></div> <div class=\"bn-form-desc\"><p>Please fill out the fields below.</p></div></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Store Number <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-1\" placeholder=\"Advance Auto Store Number\" validator=\"\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Email Address <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-2\" placeholder=\"you must enter a valid email address\" validator=\"email\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Delivery Location <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><textarea name=\"Field-3\" placeholder=\"Store or Customer Location\" validator=\"\" required=\"required\"></textarea></span></label></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Requested Delivery Date </span> <span class=\"bn-input bn-date-input\"><input type=\"text\" name=\"Field-159414934680951\" validator=\"date\" placeholder=\"mm/dd/yyyy\" value=\"\"> <span class=\"material-icons bn-date-pick\">date_range</span></span></label></div><div class=\"fields-wrapper\"><div class=\"bn-row\"><span class=\"bn-label\">Drum (55gallons) Item #1 </span> <span class=\"bn-input\"><span class=\"bn-select\"><select name=\"Field-159415037960987[]\"><option value=\"None\" selected=\"\">None</option><option value=\"Majestic 5W30 Syn-Blend \">Majestic 5W30 Syn-Blend </option><option value=\"Majestic 10W30 Syn-Blend\">Majestic 10W30 Syn-Blend</option><option value=\"Majestic 5W20 Syn-Blend\">Majestic 5W20 Syn-Blend</option><option value=\"Synthetic DEXOS 1 0W20\">Synthetic DEXOS 1 0W20</option><option value=\"Synthetic DEXOS 1 5W30\">Synthetic DEXOS 1 5W30</option><option value=\"5W20 Full Synthetic\">5W20 Full Synthetic</option><option value=\"National FS 5W40 Euro\">National FS 5W40 Euro</option><option value=\"National Elite SYN 5W40 CK4\">National Elite SYN 5W40 CK4</option><option value=\"National Elite 15W40 CK4\">National Elite 15W40 CK4</option><option value=\"National Elite 10W30 CK4\">National Elite 10W30 CK4</option><option value=\"National MultiPurpose DM\">National MultiPurpose DM</option><option value=\"National Synthetic MV\">National Synthetic MV</option><option value=\"National Universal FE SYN MV\">National Universal FE SYN MV</option><option value=\"WindShield Washer Concentrate\">WindShield Washer Concentrate</option><option value=\"Washer Fluid Ready-to-Use -20F\">Washer Fluid Ready-to-Use -20F</option><option value=\"Universal Antifreeze LD GOLD RTU\">Universal Antifreeze LD GOLD RTU</option><option value=\"Universal Antifreeze HD GOLD  RTU\">Universal Antifreeze HD GOLD  RTU</option><option value=\"Universal Antifreeze Nitrite ELC RTU\">Universal Antifreeze Nitrite ELC RTU</option><option value=\"Brake Cleaner \">Brake Cleaner </option><option value=\"Stoddard Solvent - Mineral Spirits\">Stoddard Solvent - Mineral Spirits</option><option value=\"Non-Toxic RV Anti-Freeze 30%\">Non-Toxic RV Anti-Freeze 30%</option><option value=\"Non-Toxic RV Anti-Freeze 40%\">Non-Toxic RV Anti-Freeze 40%</option><option value=\"Non-Toxic RV Anti-Freeze 50%\">Non-Toxic RV Anti-Freeze 50%</option></select></span></span></div></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Item #1 Quantity </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-159415039401982\" placeholder=\"None\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><div class=\"bn-row\"><span class=\"bn-label\">Drum (55gallons) Item #2 </span> <span class=\"bn-input\"><span class=\"bn-select\"><select name=\"Field-1608233165757103[]\"><option value=\"None\" selected=\"\">None</option><option value=\"Majestic 5W30 Syn-Blend \">Majestic 5W30 Syn-Blend </option><option value=\"Majestic 10W30 Syn-Blend\">Majestic 10W30 Syn-Blend</option><option value=\"Majestic 5W20 Syn-Blend\">Majestic 5W20 Syn-Blend</option><option value=\"Synthetic DEXOS 1 0W20\">Synthetic DEXOS 1 0W20</option><option value=\"Synthetic DEXOS 1 5W30\">Synthetic DEXOS 1 5W30</option><option value=\"5W20 Full Synthetic\">5W20 Full Synthetic</option><option value=\"National FS 5W40 Euro\">National FS 5W40 Euro</option><option value=\"National Elite SYN 5W40 CK4\">National Elite SYN 5W40 CK4</option><option value=\"National Elite 15W40 CK4\">National Elite 15W40 CK4</option><option value=\"National Elite 10W30 CK4\">National Elite 10W30 CK4</option><option value=\"National MultiPurpose DM\">National MultiPurpose DM</option><option value=\"National Synthetic MV\">National Synthetic MV</option><option value=\"National Universal FE SYN MV\">National Universal FE SYN MV</option><option value=\"WindShield Washer Concentrate\">WindShield Washer Concentrate</option><option value=\"Washer Fluid Ready-to-Use -20F\">Washer Fluid Ready-to-Use -20F</option><option value=\"Universal Antifreeze LD GOLD RTU\">Universal Antifreeze LD GOLD RTU</option><option value=\"Universal Antifreeze HD GOLD  RTU\">Universal Antifreeze HD GOLD  RTU</option><option value=\"Universal Antifreeze Nitrite ELC RTU\">Universal Antifreeze Nitrite ELC RTU</option><option value=\"Brake Cleaner \">Brake Cleaner </option><option value=\"Stoddard Solvent - Mineral Spirits\">Stoddard Solvent - Mineral Spirits</option><option value=\"Non-Toxic RV Anti-Freeze 30%\">Non-Toxic RV Anti-Freeze 30%</option><option value=\"Non-Toxic RV Anti-Freeze 40%\">Non-Toxic RV Anti-Freeze 40%</option><option value=\"Non-Toxic RV Anti-Freeze 50%\">Non-Toxic RV Anti-Freeze 50%</option></select></span></span></div></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Item #2 Quantity </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-159415042944520\" placeholder=\"None\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><div class=\"bn-row\"><span class=\"bn-label\">Drum (55gallons) Item #3 </span> <span class=\"bn-input\"><span class=\"bn-select\"><select name=\"Field-160823319075236[]\"><option value=\"None\" selected=\"\">None</option><option value=\"Majestic 5W30 Syn-Blend \">Majestic 5W30 Syn-Blend </option><option value=\"Majestic 10W30 Syn-Blend\">Majestic 10W30 Syn-Blend</option><option value=\"Majestic 5W20 Syn-Blend\">Majestic 5W20 Syn-Blend</option><option value=\"Synthetic DEXOS 1 0W20\">Synthetic DEXOS 1 0W20</option><option value=\"Synthetic DEXOS 1 5W30\">Synthetic DEXOS 1 5W30</option><option value=\"5W20 Full Synthetic\">5W20 Full Synthetic</option><option value=\"National FS 5W40 Euro\">National FS 5W40 Euro</option><option value=\"National Elite SYN 5W40 CK4\">National Elite SYN 5W40 CK4</option><option value=\"National Elite 15W40 CK4\">National Elite 15W40 CK4</option><option value=\"National Elite 10W30 CK4\">National Elite 10W30 CK4</option><option value=\"National MultiPurpose DM\">National MultiPurpose DM</option><option value=\"National Synthetic MV\">National Synthetic MV</option><option value=\"National Universal FE SYN MV\">National Universal FE SYN MV</option><option value=\"WindShield Washer Concentrate\">WindShield Washer Concentrate</option><option value=\"Washer Fluid Ready-to-Use -20F\">Washer Fluid Ready-to-Use -20F</option><option value=\"Universal Antifreeze LD GOLD RTU\">Universal Antifreeze LD GOLD RTU</option><option value=\"Universal Antifreeze HD GOLD  RTU\">Universal Antifreeze HD GOLD  RTU</option><option value=\"Universal Antifreeze Nitrite ELC RTU\">Universal Antifreeze Nitrite ELC RTU</option><option value=\"Brake Cleaner \">Brake Cleaner </option><option value=\"Stoddard Solvent - Mineral Spirits\">Stoddard Solvent - Mineral Spirits</option><option value=\"Non-Toxic RV Anti-Freeze 30%\">Non-Toxic RV Anti-Freeze 30%</option><option value=\"Non-Toxic RV Anti-Freeze 40%\">Non-Toxic RV Anti-Freeze 40%</option><option value=\"Non-Toxic RV Anti-Freeze 50%\">Non-Toxic RV Anti-Freeze 50%</option></select></span></span></div></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Item #3 Quantity </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-159415046318911\" placeholder=\"None\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><div class=\"bn-row\"><span class=\"bn-label\">Drum (55gallons) Item #4 </span> <span class=\"bn-input\"><span class=\"bn-select\"><select name=\"Field-160823331357380[]\"><option value=\"None\" selected=\"\">None</option><option value=\"Majestic 5W30 Syn-Blend \">Majestic 5W30 Syn-Blend </option><option value=\"Majestic 10W30 Syn-Blend\">Majestic 10W30 Syn-Blend</option><option value=\"Majestic 5W20 Syn-Blend\">Majestic 5W20 Syn-Blend</option><option value=\"Synthetic DEXOS 1 0W20\">Synthetic DEXOS 1 0W20</option><option value=\"Synthetic DEXOS 1 5W30\">Synthetic DEXOS 1 5W30</option><option value=\"5W20 Full Synthetic\">5W20 Full Synthetic</option><option value=\"National FS 5W40 Euro\">National FS 5W40 Euro</option><option value=\"National Elite SYN 5W40 CK4\">National Elite SYN 5W40 CK4</option><option value=\"National Elite 15W40 CK4\">National Elite 15W40 CK4</option><option value=\"National Elite 10W30 CK4\">National Elite 10W30 CK4</option><option value=\"National MultiPurpose DM\">National MultiPurpose DM</option><option value=\"National Synthetic MV\">National Synthetic MV</option><option value=\"National Universal FE SYN MV\">National Universal FE SYN MV</option><option value=\"WindShield Washer Concentrate\">WindShield Washer Concentrate</option><option value=\"Washer Fluid Ready-to-Use -20F\">Washer Fluid Ready-to-Use -20F</option><option value=\"Universal Antifreeze LD GOLD RTU\">Universal Antifreeze LD GOLD RTU</option><option value=\"Universal Antifreeze HD GOLD  RTU\">Universal Antifreeze HD GOLD  RTU</option><option value=\"Universal Antifreeze Nitrite ELC RTU\">Universal Antifreeze Nitrite ELC RTU</option><option value=\"Brake Cleaner \">Brake Cleaner </option><option value=\"Stoddard Solvent - Mineral Spirits\">Stoddard Solvent - Mineral Spirits</option><option value=\"Non-Toxic RV Anti-Freeze 30%\">Non-Toxic RV Anti-Freeze 30%</option><option value=\"Non-Toxic RV Anti-Freeze 40%\">Non-Toxic RV Anti-Freeze 40%</option><option value=\"Non-Toxic RV Anti-Freeze 50%\">Non-Toxic RV Anti-Freeze 50%</option></select></span></span></div></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Item #4 Quantity </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-159415049183762\" placeholder=\"None\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><div class=\"bn-row\"><span class=\"bn-label\">Drum (55gallons) Item #5 </span> <span class=\"bn-input\"><span class=\"bn-select\"><select name=\"Field-160823332819767[]\"><option value=\"None\" selected=\"\">None</option><option value=\"Majestic 5W30 Syn-Blend \">Majestic 5W30 Syn-Blend </option><option value=\"Majestic 10W30 Syn-Blend\">Majestic 10W30 Syn-Blend</option><option value=\"Majestic 5W20 Syn-Blend\">Majestic 5W20 Syn-Blend</option><option value=\"Synthetic DEXOS 1 0W20\">Synthetic DEXOS 1 0W20</option><option value=\"Synthetic DEXOS 1 5W30\">Synthetic DEXOS 1 5W30</option><option value=\"5W20 Full Synthetic\">5W20 Full Synthetic</option><option value=\"National FS 5W40 Euro\">National FS 5W40 Euro</option><option value=\"National Elite SYN 5W40 CK4\">National Elite SYN 5W40 CK4</option><option value=\"National Elite 15W40 CK4\">National Elite 15W40 CK4</option><option value=\"National Elite 10W30 CK4\">National Elite 10W30 CK4</option><option value=\"National MultiPurpose DM\">National MultiPurpose DM</option><option value=\"National Synthetic MV\">National Synthetic MV</option><option value=\"National Universal FE SYN MV\">National Universal FE SYN MV</option><option value=\"WindShield Washer Concentrate\">WindShield Washer Concentrate</option><option value=\"Washer Fluid Ready-to-Use -20F\">Washer Fluid Ready-to-Use -20F</option><option value=\"Universal Antifreeze LD GOLD RTU\">Universal Antifreeze LD GOLD RTU</option><option value=\"Universal Antifreeze HD GOLD  RTU\">Universal Antifreeze HD GOLD  RTU</option><option value=\"Universal Antifreeze Nitrite ELC RTU\">Universal Antifreeze Nitrite ELC RTU</option><option value=\"Brake Cleaner \">Brake Cleaner </option><option value=\"Stoddard Solvent - Mineral Spirits\">Stoddard Solvent - Mineral Spirits</option><option value=\"Non-Toxic RV Anti-Freeze 30%\">Non-Toxic RV Anti-Freeze 30%</option><option value=\"Non-Toxic RV Anti-Freeze 40%\">Non-Toxic RV Anti-Freeze 40%</option><option value=\"Non-Toxic RV Anti-Freeze 50%\">Non-Toxic RV Anti-Freeze 50%</option></select></span></span></div></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Item #5 Quantity </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-159414948108489\" placeholder=\"None\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Delivery Notes </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-159415059862282\" placeholder=\"\" validator=\"\" value=\"\"></span></label></div>  <input type=\"hidden\" name=\"carboncopy\" value=\"Robbie@brownsoilservice.com\"> <input type=\"hidden\" name=\"thankyou\" value=\"\"> <input type=\"hidden\" name=\"thankyoutext\" value=\"Thank You, Your Order has been set!\"> <input type=\"hidden\" name=\"subject\" value=\"Advance Auto - 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