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=3821&formpadding=0\"><form method=\"post\" class=\"bnet-form\" enctype=\"multipart/form-data\" action=\"#bn-ajax-post:4277634906:50:3821\"><div class=\"bn-form-header\"><div class=\"bn-form-legend\"><div>IndyGo Fleet Oil &amp; Lubricants IFB18-01-282</div></div> <div class=\"bn-form-desc\"><p>Order Form</p></div></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Purchaser Name <span class=\"bn-required\">*</span></span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-1\" placeholder=\"Your first and last name\" validator=\"\" required=\"required\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Request delivery before this date </span> <span class=\"bn-input bn-date-input\"><input type=\"text\" name=\"Field-159864734905298\" validator=\"date\" placeholder=\"mm/dd/yyyy\" value=\"\"> <span class=\"material-icons bn-date-pick\">date_range</span></span></label></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">PO Number </span> <span class=\"bn-input\"><input type=\"text\" name=\"Field-159864587682124\" placeholder=\"PO#10223\" validator=\"\" value=\"PO#10223\"></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\"><div class=\"bn-row\"><span class=\"bn-label\">Item #1 - Product </span> <span class=\"bn-input\"><span class=\"bn-select\"><select name=\"Field-159864601350135[]\"><option value=\"None\" selected=\"\">None</option><option value=\"National Elite Engine Oil SAE 15W40 / PART #07-603554 (Gallon)\">National Elite Engine Oil SAE 15W40 / PART #07-603554 (Gallon)</option><option value=\"FleetGuard ES Compleat HD Coolant / PART #CC2872 (Gallon)\">FleetGuard ES Compleat HD Coolant / PART #CC2872 (Gallon)</option><option value=\"TES 295 Automatic Transmission Fluid / PART #BP709701 (Gallon)\">TES 295 Automatic Transmission Fluid / PART #BP709701 (Gallon)</option><option value=\"Marathon EP2 Grease 400lbs (Drum)\">Marathon EP2 Grease 400lbs (Drum)</option><option value=\"Marathon Engine Oil SAE 5W20 (12 Quart Case)\">Marathon Engine Oil SAE 5W20 (12 Quart Case)</option><option value=\"Marathon Engine Oil SAE  5W30 (12 Quart Case)\">Marathon Engine Oil SAE  5W30 (12 Quart Case)</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-159864869071654\" placeholder=\"Quantity\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><div class=\"bn-row\"><span class=\"bn-label\">Item #2 - Product </span> <span class=\"bn-input\"><span class=\"bn-select\"><select name=\"Field-159864844679765[]\"><option value=\"None\" selected=\"\">None</option><option value=\"National Elite Engine Oil SAE 15W40 / PART #07-603554 (Gallon)\">National Elite Engine Oil SAE 15W40 / PART #07-603554 (Gallon)</option><option value=\"FleetGuard ES Compleat HD Coolant / PART #CC2872 (Gallon)\">FleetGuard ES Compleat HD Coolant / PART #CC2872 (Gallon)</option><option value=\"TES 295 Automatic Transmission Fluid / PART #BP709701 (Gallon)\">TES 295 Automatic Transmission Fluid / PART #BP709701 (Gallon)</option><option value=\"Marathon EP2 Grease 400lbs (Drum)\">Marathon EP2 Grease 400lbs (Drum)</option><option value=\"Marathon Engine Oil SAE 5W20 (12 Quart Case)\">Marathon Engine Oil SAE 5W20 (12 Quart Case)</option><option value=\"Marathon Engine Oil SAE  5W30 (12 Quart Case)\">Marathon Engine Oil SAE  5W30 (12 Quart Case)</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=\"-159864849244262\" placeholder=\"Quantity\" validator=\"\" value=\"\"></span></label></div><div class=\"fields-wrapper\"><label class=\"bn-row\"><span class=\"bn-label\">Delivery Instructions </span> <span class=\"bn-input\"><textarea name=\"Field-159864869071663\" placeholder=\"\" validator=\"\"></textarea></span></label></div>  <input type=\"hidden\" name=\"carboncopy\" value=\"robbie@brownsoilservice.com,greg@brownsoilservice.com\"> <input type=\"hidden\" name=\"thankyou\" value=\"\"> <input type=\"hidden\" name=\"thankyoutext\" value=\"Your order has been sent! 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