Choose Your Shirt Design and Sizing Below

<script LANGUAGE="JavaScript"><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] -->function emailCheck() {<!-- [et_pb_line_break_holder] --> var reg = /^([A-Za-z0-9_\-\.])+\@([A-Za-z0-9_\-\.])+\.([A-Za-z]{2,4})$/;<!-- [et_pb_line_break_holder] --> var address = document.form2.s_email.value;<!-- [et_pb_line_break_holder] -->if (document.form2.s_email.value=="") {<!-- [et_pb_line_break_holder] --> alert("Please enter your email address.");document.form2.s_email.focus();return false;<!-- [et_pb_line_break_holder] -->}<!-- [et_pb_line_break_holder] -->if(reg.test(address) == false) {<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --> alert('Please enter the valid Email Address'); document.form2.s_email.focus();return false;<!-- [et_pb_line_break_holder] -->}<!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] -->if (document.getElementById('include_choice1').checked && document.getElementById('include_choice2').checked && document.getElementById('include_choice').checked && document.getElementById('include_choice').checked && document.getElementById('include_choice5').checked) {<!-- [et_pb_line_break_holder] -->alert("Please choice one option best describes you");return false<!-- [et_pb_line_break_holder] -->}}<!-- [et_pb_line_break_holder] --></script><!-- [et_pb_line_break_holder] --><form action="https://cydec.com/cydec/communication/subscribe.php" method="POST" NAME="form2" onSubmit="return emailCheck()"><!-- [et_pb_line_break_holder] --><input type="hidden" name="listid" value="28"><!-- [et_pb_line_break_holder] --><input type="hidden" name="userid" value="4112"><!-- [et_pb_line_break_holder] --><input type="hidden" name="redirect" value="http://clickandgrowrich.com/shirt-sizing-thankyou"><!-- [et_pb_line_break_holder] --><style><!-- [et_pb_line_break_holder] -->table, th, td {<!-- [et_pb_line_break_holder] --> border: 0px solid rgba(0, 0, 0, 0.1);<!-- [et_pb_line_break_holder] -->}<!-- [et_pb_line_break_holder] -->td {<!-- [et_pb_line_break_holder] --> text-align: center;<!-- [et_pb_line_break_holder] -->}<!-- [et_pb_line_break_holder] --></style> <!-- [et_pb_line_break_holder] --> <div id="optin_d1" style=" width: 620px; font-family: arial,helvetica,tahoma,sans-serif; padding: 2px;"><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --> <div id="odh" style="text-align: center; font-weight: bold; color: rgb(255, 255, 255); font-size: 23px; padding: 10px; line-height: initial; background-color: #000000;">Please Fill in Your Personal Information Below Including Your Shirt Quantity and Size(s)</div><!-- [et_pb_line_break_holder] --> <div id="optin_inner" align="center" style="margin: 0px auto 5px; width: 600px;" align="center"> <!-- [et_pb_line_break_holder] --> <table border="0" cellpadding="4" cellspacing="0" align="center">'<!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td> <input name="s_first_name" value="" size="20" placeholder="First Name:" style="background-color: #E9E9E9;font-size: 16px; color: #666666; border: 0px; margin-right: 10px; margin-top: 10px;vertical-align:top;width:250px;background:#E9E9E9 url(https://cydec.com/cydec/images/subs_images/icon_name.png) no-repeat 5px 4px; padding: 8px 10px 8px 35px;"> <input name="s_last_name" value="" size="20" placeholder="Last Name:" style="background-color: #E9E9E9;font-size: 16px; color: #666666; border: 1px solid #E9E9E9; margin-right: 10px; margin-top: 10px;vertical-align:top;padding: 8px 10px 8px 0px;width:250px;"> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td> <input name="s_email" value="" size="20" placeholder="Email:" style="background-color: #E9E9E9;font-size: 16px; color: #666666; border: 1px solid #E9E9E9; margin-right: 10px; margin-top: 10px;vertical-align:top;width:250px;background:#E9E9E9 url(https://cydec.com/cydec/images/subs_images/icon_email.png) no-repeat 5px 8px; padding: 8px 10px 8px 40px;"> <input name="address" value="" size="20" placeholder="Address:" style="background-color: #E9E9E9;font-size: 16px; color: #666666; border: 1px solid #E9E9E9; margin-right: 10px; margin-top: 10px;vertical-align:top;padding: 8px 10px 8px 0px;width:250px;"> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td> <input name="city" value="" size="20" placeholder="City:" style="background-color: #E9E9E9;font-size: 16px; color: #666666; border: 1px solid #E9E9E9; margin-right: 10px; margin-top: 10px;vertical-align:top;padding: 8px 10px 8px 0px;width:250px;"> <input name="state" value="" size="20" placeholder="State:" style="background-color: #E9E9E9;font-size: 16px; color: #666666; border: 1px solid #E9E9E9; margin-right: 10px; margin-top: 10px;vertical-align:top;padding: 8px 10px 8px 0px;width:250px;"> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td> <input name="zip" value="" size="20" placeholder="Zip:" style="background-color: #E9E9E9;font-size: 16px; color: #666666; border: 1px solid #E9E9E9; margin-right: 10px; margin-top: 10px;vertical-align:top;padding: 8px 10px 8px 0px;width:250px;"> <input name="country" value="" size="20" placeholder="Country:" style="background-color: #E9E9E9;font-size: 16px; color: #666666; border: 1px solid #E9E9E9; margin-right: 10px; margin-top: 10px;vertical-align:top;padding: 8px 10px 8px 0px;width:250px;"> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td> <input name="bus_phone" value="" size="20" placeholder="Bus Phone:" style="background-color: #E9E9E9;font-size: 16px; color: #666666; border: 1px solid #E9E9E9; margin-right: 10px; margin-top: 10px;vertical-align:top;padding: 8px 10px 8px 0px;width:250px;"> <input name="include_custom1" value="" size="20" placeholder="Number of Shirts Ordered (1-2):" style="background-color: #E9E9E9;font-size: 16px; color: #666666; border: 1px solid #E9E9E9; margin-right: 10px; margin-top: 10px;vertical-align:top;padding: 8px 10px 8px 0px;width:250px;"> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td> <input name="include_custom2" value="" size="20" placeholder="Select Shirt Design #1 (White) #2 (Red / Grey) or #3 (Red / Wht / Blk):" style="background-color: #E9E9E9;font-size: 16px; color: #666666; border: 1px solid #E9E9E9; margin-right: 10px; margin-top: 10px;vertical-align:top;padding: 8px 10px 8px 0px;width:510px;"> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr><!-- [et_pb_line_break_holder] --> <td> </td><!-- [et_pb_line_break_holder] --> </tr> <tr><!-- [et_pb_line_break_holder] --> <td style=" text-align: left;color:#666666;"><!-- [et_pb_line_break_holder] --><p style="font-size:20px">Please select your shirt size below:</p><!-- [et_pb_line_break_holder] --> </td></tr> <tr><!-- [et_pb_line_break_holder] --> <td style=" text-align: left;"><!-- [et_pb_line_break_holder] --> <input type="checkbox" name="include_choice1" id="include_choice1" style="color: #666666;border: 1px solid #E9E9E9;background: #E9E9E9;width:36px;padding: 8px 10px;"> <span style="font-size: 16px;color: #666666;">Small T-Shirt</span><!-- [et_pb_line_break_holder] --> <input type="hidden" name="l_include_choice1" value="28"> <!-- [et_pb_line_break_holder] --></td></tr> <tr><!-- [et_pb_line_break_holder] --> <td style=" text-align: left;"><!-- [et_pb_line_break_holder] --> <input type="checkbox" name="include_choice2" id="include_choice2" style="color: #666666;border: 1px solid #E9E9E9;background: #E9E9E9;width:36px;padding: 8px 10px;"> <span style="font-size: 16px;color: #666666;">Med T-Shirt</span><!-- [et_pb_line_break_holder] --> <input type="hidden" name="l_include_choice2" value="28"> <!-- [et_pb_line_break_holder] --></td></tr> <tr><!-- [et_pb_line_break_holder] --> <td style=" text-align: left;"><!-- [et_pb_line_break_holder] --> <input type="checkbox" name="include_choice3" id="include_choice3" style="color: #666666;border: 1px solid #E9E9E9;background: #E9E9E9;width:36px;padding: 8px 10px;"> <span style="font-size: 16px;color: #666666;">Large T-Shirt</span><!-- [et_pb_line_break_holder] --> <input type="hidden" name="l_include_choice3" value="28"> <!-- [et_pb_line_break_holder] --></td></tr> <tr><!-- [et_pb_line_break_holder] --> <td style=" text-align: left;"><!-- [et_pb_line_break_holder] --> <input type="checkbox" name="include_choice4" id="include_choice4" style="color: #666666;border: 1px solid #E9E9E9;background: #E9E9E9;width:36px;padding: 8px 10px;"> <span style="font-size: 16px;color: #666666;">XLarge T-Shirt</span><!-- [et_pb_line_break_holder] --> <input type="hidden" name="l_include_choice4" value="28"> <!-- [et_pb_line_break_holder] --></td></tr> <tr><!-- [et_pb_line_break_holder] --> <td style=" text-align: left;"><!-- [et_pb_line_break_holder] --> <input type="checkbox" name="include_choice5" id="include_choice5" style="color: #666666;border: 1px solid #E9E9E9;background: #E9E9E9;width:36px;padding: 8px 10px;"> <span style="font-size: 16px;color: #666666;">XXLarge T-Shirt</span><!-- [et_pb_line_break_holder] --> <input type="hidden" name="l_include_choice5" value="28"> <!-- [et_pb_line_break_holder] --></td></tr> <tr><!-- [et_pb_line_break_holder] --> <td colspan="2" align="center"><!-- [et_pb_line_break_holder] --> <input type="submit" value="Submit" style="background: none repeat scroll 0 0 #000000;border: 1px solid #000000;border-radius: 8px;box-shadow: 0 1px 0 '.#000000.' inset, 0 2px 0 0 '.#000000.', 0 2px 2px #000000;color: #fff;cursor: pointer;font-family: arial,helvetica,tahoma,sans-serif;font-size: 1.5em;padding: 2px;text-shadow: 0 -1px 0 #000000;width: 180px;"><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --></table> <!-- [et_pb_line_break_holder] --> </div></div> <!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --></form><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p style="font-size:20px">* Shirt quantity orders will be verified prior to shipping</p>