document.write("<style>.formbutton{border:1px solid #1 !important;background-color:#C62026 !important;color:#FEFEFE !important;font-size:12px !important;font-weight:400 !important;border-radius:0px !important;padding:0px 20px !important;margin:3px 3px !important;}</style><style>.form-control {padding:0px 12px !important;}</style><link rel='stylesheet' href='https://mypremierdj.com/clients/includes/mobile-framework.css'><link rel='stylesheet' href='https://mypremierdj.com/includes/style-responsivetools-min.css'><script>if(!window.jQuery){var script = document.createElement('script');script.type = 'text/javascript';script.src = 'https://ajax.googleapis.com/ajax/libs/jquery/1.8.1/jquery.min.js';document.getElementsByTagName('head')[0].appendChild(script);}</script><form  method='post' action='https://mypremierdj.com/request_information.asp' onSubmit='return submitIt(this);' name='reqinfoform' style='margin:10px 20px;'><input type='hidden' name='checkdate' value=''><input type='hidden' name='djidnumber' value='24919'><input type='hidden' name='action' value='add_information_request'><div class='djepcode'><div style='font-size:10pt;font-family:Roboto,Verdana,Arial;color:#FEFEFE;background-color:#C62026;color:#FEFEFE;' align='center'><div style='padding:8px;'><strong>Premier Entertainment<br>Request For Information Form</strong></div></div><div style='padding:13px;color:#FFFFFF;'><div class='form-group'><div class='col-sm-4 col-md-3 padding-tb-7'><div class='padding-lr-5'>Date Of Event</div></div><div class='col-sm-8 col-md-9'><span class='metro-table' id='date_select'><select name=month class='form-control monthselect' style='float:left;width:31%;margin:2px;' ><option value=43>Month</option><option value=1>January (1)</option><option value=2>February (2)</option><option value=3>March (3)</option><option value=4>April (4)</option><option value=5>May (5)</option><option value=6>June (6)</option><option value=7>July (7)</option><option value=8>August (8)</option><option value=9>September (9)</option><option value=10>October (10)</option><option value=11>November (11)</option><option value=12>December (12)</option></select><select name=day class='form-control dayselect' style='float:left;width:31%;margin:2px;' ><option value=43>Day<option value=1>1</option><option value=2>2</option><option value=3>3</option><option value=4>4</option><option value=5>5</option><option value=6>6</option><option value=7>7</option><option value=8>8</option><option value=9>9</option><option value=10>10</option><option value=11>11</option><option value=12>12</option><option value=13>13</option><option value=14>14</option><option value=15>15</option><option value=16>16</option><option value=17>17</option><option value=18>18</option><option value=19>19</option><option value=20>20</option><option value=21>21</option><option value=22>22</option><option value=23>23</option><option value=24>24</option><option value=25>25</option><option value=26>26</option><option value=27>27</option><option value=28>28</option><option value=29>29</option><option value=30>30</option><option value=31>31</option></select><select name=year class='form-control yearselect' style='float:left;width:31%;margin:2px;' ><option value=43>Year</option><option value=2022>2022</option><option value=2023>2023</option><option value=2024>2024</option><option value=2025 selected>2025</option><option value=2026>2026</option><option value=2027>2027</option><option value=2028>2028</option><option value=2029>2029</option><option value=2030>2030</option><option value=2031>2031</option><option value=2032>2032</option><option value=2033>2033</option><option value=2034>2034</option><option value=2035>2035</option><option value=2036>2036</option><option value=2037>2037</option><option value=2038>2038</option><option value=2039>2039</option><option value=2040>2040</option><option value=2041>2041</option><option value=2042>2042</option><option value=2043>2043</option><option value=2044>2044</option><option value=2045>2045</option><option value=2046>2046</option><option value=2047>2047</option><option value=2048>2048</option><option value=2049>2049</option><option value=2050>2050</option></select></span></div><div class='cf'></div><div style='height:0px;'></div></div><div class='form-group'><div class='col-sm-4 col-md-3 padding-tb-7'><div class='padding-lr-5'>First Name</div></div><div class='col-sm-8 col-md-9'><input type='text' class='form-control width90hack' id='first_name' name='first_name'></div><div class='cf'></div><div style='height:0px;'></div></div><div class='form-group'><div class='col-sm-4 col-md-3 padding-tb-7'><div class='padding-lr-5'>Last Name</div></div><div class='col-sm-8 col-md-9'><input type='text' class='form-control width90hack' id='last_name' name='last_name'></div><div class='cf'></div><div style='height:0px;'></div></div><div class='form-group'><div class='col-sm-4 col-md-3 padding-tb-7'><div class='padding-lr-5'>Email Address (please confirm spelling)</div></div><div class='col-sm-8 col-md-9'><input type='text' class='form-control width90hack' id='email' name='email'></div><div class='cf'></div><div style='height:0px;'></div></div><div class='form-group'><div class='col-sm-4 col-md-3 padding-tb-7'><div class='padding-lr-5'>Mobile Number</div></div><div class='col-sm-8 col-md-9'><input type='tel' class='form-control width90hack' id='telephone' name='telephone'></div><div class='cf'></div><div style='height:0px;'></div></div><div class='form-group'><div class='col-sm-4 col-md-3 padding-tb-7'><div class='padding-lr-5'>Type Of Event</div></div><div class='col-sm-8 col-md-9'><select name=event_type class='form-control responsive-form-select'><option value=''>Please select...</option><option >After Party</option><option >Bar/Bat Mitzvah</option><option >Birthday Party</option><option >Class Reunion</option><option >Corporate Event</option><option >Fundraiser</option><option >Karaoke</option><option >Night Club / Bar Dance</option><option >Photo Booth</option><option >Private Party</option><option >Rehearsal</option><option >Wedding Anniversary</option><option >Wedding</option><option >Other / Not Listed</option><option >Open House / Showcase</option></select></div><div class='cf'></div><div style='height:0px;'></div></div><div class='form-group'><div class='form-group'><div class='col-sm-4 col-md-3 padding-tb-7'><div class='padding-lr-5'>How did you hear about us?<input type=hidden name=q1_mapto value=inquiry_source></div></div><div class='col-sm-8 col-md-9'><select class='form-control width90hack' name=question_1><option value=''>Please select...</option><option>Wedding Coordinator</option><option>Venue</option><option>The Knot</option><option>Wedding Wire</option><option>Google</option><option>Instagram</option><option>Facebook</option><option>Referral/Previous Client</option><option>Wedding Showcase</option></select></div><div class='cf'></div><div style='height:0px;'></div></div></div><div class='form-group'><div class='col-sm-10 col-sm-offset-2'><p><label class='questiontitle'><input type=checkbox name=sms_consent value='true'>By checking this box, you consent to communication from Premier Entertainment via email, phone, and SMS. Msg & data rates may apply.</label><br class='visible-xs hidden-sm hidden-md hidden-lg'></p></div></div><br><p align='center'><input type=submit name=submit value=Submit class='formbutton'></p><br></div></div></form>")