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<html>
<head>
<title>Example form for posting through formmail.cgi</title>
<meta http-equiv="Content-Type"
content="text/html;
charset=iso-8859-1">
</head>
<body bgcolor="#FFFFFF"
text="#000000">
<form name="formmail"
action="/cgi-bin/formmail/formmail.cgi"
method="post">
<input type=hidden name="recipient" value="webmaster@yourcompany.com">
<input type=hidden name="subject" value="Web Design request
from yoursite.com">
<input type=hidden name="redirect" value="http://www.yourdomain.com/formresponder.html">
<input type=hidden name="required" value="name,company,telephone">
<input type=hidden name="env_report" value="REMOTE_HOST,HTTP_USER_AGENT">
<input type=hidden name="sort" value="alphabetic">
<input type=hidden name="print_blank_fields" value="1">
<table width="410" border="0" cellpadding="2">
<tr valign="top">
<td colspan="3">
<center>
If you would like to request a quotation for one of these templates or
would like
to receive a custom web design quotation, please complete this form.
</center>
</td>
</tr>
<tr valign="top">
<td width="175"> </td>
<td colspan="2"> </td>
</tr>
<tr valign="top">
<td>
<div align="right"><font size="2" face="Arial,
Helvetica, sans-serif">Name : </font></div>
</td>
<td colspan="2"><label>
<input name="name" type="text" id="name">
</label></td>
</tr>
<tr valign="top">
<td>
<div align="right"><font size="2" face="Arial,
Helvetica, sans-serif">Company :
</font></div>
</td>
<td colspan="2"><label>
<input name="company" type="text" id="company">
</label> </td>
</tr>
<tr valign="top">
<td>
<div align="right"><font size="2" face="Arial,
Helvetica, sans-serif">Address :
</font></div>
</td>
<td colspan="2">
<input name="address" type="text" id="address">
</td>
</tr>
<tr valign="top">
<td>
<div align="right"><font size="2" face="Arial,
Helvetica, sans-serif">Address
2 : </font></div>
</td>
<td colspan="2">
<input name="address2" type="text" id="address2">
</td>
</tr>
<tr valign="top">
<td>
<div align="right"><font size="2" face="Arial,
Helvetica, sans-serif">City
: </font></div>
</td>
<td colspan="2">
<input name="city" type="text" id="city">
</td>
</tr>
<tr valign="top">
<td>
<div align="right"><font size="2" face="Arial,
Helvetica, sans-serif">State/Province
: </font></div>
</td>
<td colspan="2">
<input name="state" type="text" id="state">
</td>
</tr>
<tr valign="top">
<td>
<div align="right"><font size="2" face="Arial,
Helvetica, sans-serif">Postal/Zip
: </font></div>
</td>
<td colspan="2">
<input name="zip" type="text" id="zip">
</td>
</tr>
<tr valign="top">
<td>
<div align="right"><font size="2" face="Arial,
Helvetica, sans-serif">E-mail
: </font></div>
</td>
<td colspan="2">
<input name="email" type="text" id="email">
</td>
</tr>
<tr valign="top">
<td>
<div align="right"><font size="2" face="Arial,
Helvetica, sans-serif">Telephone
:</font></div>
</td>
<td colspan="2">
<input name="telephone" type="text" id="phone">
</td>
</tr>
<tr valign="top">
<td>
<div align="right"><font face="Arial, Helvetica,
sans-serif"><font face="Arial, Helvetica, sans-serif"><font
size="2"></font></font></font></div>
</td>
<td colspan="2"> </td>
</tr>
<tr valign="top">
<td colspan="2" nowrap>
<div align="right"><font size="2" face="Arial,
Helvetica, sans-serif">Do you
have a domain name? </font></div>
<font size="2" face="Arial, Helvetica, sans-serif">
<label> </label> </font></td>
<td width="181" nowrap><font size="2" face="Arial,
Helvetica, sans-serif">
<label>
<input type="radio" name="domain" value="no">
No
<input type="radio" name="domain" value="yes">
Yes</label> </font></td>
</tr>
<tr valign="top">
<td colspan="2">
<div align="right"><font size="2" face="Arial,
Helvetica, sans-serif">Do you
have a web site? </font></div>
<font size="2" face="Arial, Helvetica, sans-serif">
</font></td>
<td nowrap><font size="2" face="Arial, Helvetica,
sans-serif">
<input type="radio" name="website" value="no">
No
<input type="radio" name="website" value="yes">
Yes</font></td>
</tr>
<tr valign="top">
<td height="35" colspan="2" nowrap>
<div align="RIGHT"><font size="2" face="Arial,
Helvetica, sans-serif">Do you
have e-mail using your own domain name?<br>
<font size="1">i.e. yourname@yourdomain.com </font></font></div>
</td>
<td nowrap><font size="2" face="Arial, Helvetica,
sans-serif">
<input type="radio" name="email" value="no">
No
<input type="radio" name="email" value="yes">
Yes <br>
<br>
</font></td>
</tr>
<tr>
<td valign="top" height="120">
<div align="right"><font size="2" face="Arial,
Helvetica, sans-serif">Will
you require special programming or services?</font></div>
</td>
<td colspan="2" valign="top" height="120">
<p><font size="2" face="Arial, Helvetica, sans-serif">
<label>
<input type="checkbox" name="forms" value="checkbox">
Forms
<input type="checkbox" name="searchtools" value="checkbox">
Search Tools
<input type="checkbox" name="intranet" value="checkbox">
Intranet<br>
<input type="checkbox" name="ppd" value="checkbox">
Password Protected Directories<br>
<input type="checkbox" name="ecommerce" value="checkbox">
e-commerce
<input type="checkbox" name="searchengines" value="checkbox">
Search Engines <br>
<input type="checkbox" name="marketing" value="checkbox">
Marketing Support
<input type="checkbox" name="tracking" value="checkbox">
Tracking tools</label> <br>
<label>
<input type="checkbox" name="multipleusers" value="checkbox">
Multiple Users
<input type="checkbox" name="controlpanel" value="checkbox">
Friendly Control Panel </label> </font></p>
</td>
</tr>
<tr valign="top">
<td>
<div align="right"><font size="2" face="Arial,
Helvetica, sans-serif">Comments
or Questions : </font></div>
</td>
<td colspan="2"><font size="2" face="Arial,
Helvetica, sans-serif"> <label>
<textarea name="comments" cols="30" rows="5"
id="comments"></textarea>
</label> </font></td>
</tr>
<tr>
<td> </td>
<td width="125"> </td>
<td> </td>
</tr>
<tr>
<td> </td>
<td colspan="2">
<input name="submit" type="submit" value="Submit
Design Request">
<input name="reset" type="reset" value="Reset
Form">
</td>
</tr>
</table>
<br>
</form>
</body>
</html> |
