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======================================================================== Internal Data Do Not Alter ======================================================================== //2017 [[Time - am/pm]] [[Agent Initials]] [[LEC Initials]] [[TT#]] [[S/W]] [[Carrier Update]] [[Carrier Lvl]] [[LEC Lvl]] [[Customers Address]] [[Site LCON]] [[Customer contact number]] [[Customer email]] [[Circuit ID]] [[Account Number]] ======================================================================== Output: Copy and Paste From below ======================================================================== //2017 [[Time - am/pm]] [[Agent Initials]] [[LEC Initials]] TT# [[TT#]] S/W: [[S/W]] Update: [[Carrier Update]] Carrier Lvl: [[Carrier Lvl]] LEC Lvl: [[LEC Lvl]] Physical Address: [[Customers Address]] Name: [[Site LCON]] Phone: [[Customer contact number]] Email: [[Customer email]] Circuit ID: [[Circuit ID]] Account#: [[Account Number]]

Time - am/pm:
Agent Initials:
LEC Initials:
TT#:
S/W:
Carrier Update:
Carrier Lvl:
LEC Lvl:
Customers Address:
Site LCON:
Customer contact number:
Customer email:
Circuit ID:
Account Number:

Use this code to post the full script to your own page:

<iframe src="http://4peg.com/558MS8MZP913?iframe=true"></iframe>

Use this code to post only the variables to your own page:

<form action="http://4peg.com/558MS8MZP913" autocomplete="on"> <table><tr><td>Time - am/pm:</td><td><input type="text" name="Time+-+am%2Fpm" id="Time+-+am%2Fpm" /> </td></tr> <tr><td>Agent Initials:</td><td><input type="text" name="Agent+Initials" id="Agent+Initials" /> </td></tr> <tr><td>LEC Initials:</td><td><input type="text" name="LEC+Initials" id="LEC+Initials" /> </td></tr> <tr><td>TT#:</td><td><input type="text" name="TT%23" id="TT%23" /> </td></tr> <tr><td>S/W:</td><td><input type="text" name="S%2FW" id="S%2FW" /> </td></tr> <tr><td>Carrier Update:</td><td><input type="text" name="Carrier+Update" id="Carrier+Update" /> </td></tr> <tr><td>Carrier Lvl:</td><td><input type="text" name="Carrier+Lvl" id="Carrier+Lvl" /> </td></tr> <tr><td>LEC Lvl:</td><td><input type="text" name="LEC+Lvl" id="LEC+Lvl" /> </td></tr> <tr><td>Customers Address:</td><td><input type="text" name="Customers+Address" id="Customers+Address" /> </td></tr> <tr><td>Site LCON:</td><td><input type="text" name="Site+LCON" id="Site+LCON" /> </td></tr> <tr><td>Customer contact number:</td><td><input type="text" name="Customer+contact+number" id="Customer+contact+number" /> </td></tr> <tr><td>Customer email:</td><td><input type="text" name="Customer+email" id="Customer+email" /> </td></tr> <tr><td>Circuit ID:</td><td><input type="text" name="Circuit+ID" id="Circuit+ID" /> </td></tr> <tr><td>Account Number:</td><td><input type="text" name="Account+Number" id="Account+Number" /> </td></tr> </table><input type="submit" value="Fill Out" /></form>