<html>

<head>
<title>Application Form</title>
</head>

<body bgcolor="#FFFFDD" id="topo">
<!---MAIN TABLE--->
<table border="0" cellpadding="5" cellspacing="0" width="600">
    <tr>
        <td valign="top"><br>
        <h1 align="center">Application form with HTML</h1>
        <p align="center"><font size="5">Fill in the form below.</font>
        This form is to receive comments about this and other of
        our work. Your opinion is very important to improve the
        quality of our work. Fill in at least
        the NAME and E-MAIL fields. Design by R.Bose.</p>
        <form action="" method="POST">
            <div align="center"><center><table border="0"
            cellpadding="2" cellspacing="0">
                <tr>
                    <td><b>Name:</b> </td>
                    <td colspan="3"><input type="text" size="60"
                    maxlength="60" name="name"> </td>
                </tr>
                <tr>
                    <td><b>Address:</b> </td>
                    <td colspan="3"><input type="text" size="60"
                    maxlength="60" name="address"> </td>
                </tr>
                <tr>
                    <td><b>City:</b> </td>
                    <td><input type="text" size="24"
                    maxlength="50" name="city"> </td>
                    <td><b>State:</b> </td>
                    <td><select name="state" size="1">
                        <option>WB</option>
                        <option>UP</option>
                        <option>MP</option>
                        <option>JH</option>
                        <option>KA</option>
                        <option>KL</option>
						<option>OTHER</option>
                       
                    </select> </td>
                </tr>
                <tr>
                    <td><b>Tel:</b> </td>
                    <td><input type="text" size="24"
                    maxlength="24" name="tel"> </td>
                    <td><b>Fax:</b> </td>
                    <td><input type="text" size="24"
                    maxlength="24" name="fax"> </td>
                </tr>
                <tr>
                    <td><b>E-mail:</b> </td>
                    <td colspan="3"><input type="text" size="60"
                    maxlength="60" name="email"> </td>
                </tr>
                <tr>
                    <td> </td>
                    <td colspan="3"><br>
                    <input type="radio" name="oque"
                    value="comentario"> Comments <input
                    type="radio" checked name="oque" value="mala">Include
                    or update my register</td>
                </tr>
                <tr>
                    <td> </td>
                    <td colspan="3"><input type="text" size="60"
                    maxlength="60" name="subject"> </td>
                </tr>
                <tr>
                    <td valign="top"><b>Text:</b> </td>
                    <td colspan="3"><textarea name="text"
                    rows="10" cols="60" wrap="60"></textarea><br>
                    </td>
                </tr>
                <tr>
                    <td> </td>
                    <td colspan="3"><input type="submit"
                    value="Send the data "> <input type="reset"
                    value="Clear the data"> </td>
                </tr>
            </table>
            </center></div>
        </form>
        <p><!---END OF MAIN TABLE---> </p>
        </td>
    </tr>
</table>
</body>
</html>
Please follow and like us:
Categories: HTML5

0 Comments

Leave a Reply

Your email address will not be published. Required fields are marked *

RSS
Follow by Email