Please fill the form compeletly!
Personal Information
First Name
M.I
Last Name
Address Information
City
Country
Zip Code(if any)
Telephone Number
(
)-
Email Address
Comments
can we contact you?
Yes
No
<!-- TWO STEPS TO INSTALL :--> <!-- 1. Copy the code into your HTML editor, like notpad 2. Name and Save, then view into your brower --> <!-- Note: the tags surround this is called coment-tags --> <FORM ACTION="http://www.kudadaal.com/myform" METHOD="POST"> <INPUT TYPE="Hidden" NAME="" VALUE=""> <INPUT TYPE="Hidden" NAME="" VALUE=""> <INPUT TYPE="Hidden" NAME=""> <FONT SIZE="4" COLOR="#333333" FACE="Verdana, sans-serif, Arial"> <center> Please fill the form compeletly! <BR> </FONT> <br> <FONT SIZE="-1" FACE="Verdana, sans-serif, Arial" COLOR="#6666ff"> <B> Personal Information </B> </FONT> <br> <!-- Line 1 --> <TABLE BORDER="0" CELLPADDING="2" CELLSPACING="1" align=center bgcolor="white"> <TR> <td colspan= align="left"> <TD VALIGN="bottom"> <FONT SIZE="-2" COLOR= #333333 FACE="Verdana, sans-serif, Arial">First Name </FONT> <BR> <INPUT TYPE="TEXT" NAME="FN" VALUE="" SIZE=13 MAXLENGTH=12> </TD> <TD VALIGN="bottom"> <FONT SIZE="-2" COLOR=#333333 FACE="Verdana, sans-serif, Arial">M.I </FONT> <BR> <INPUT TYPE="TEXT" NAME="MI" VALUE="" SIZE=1 MAXLENGTH=1> </TD> <TD VALIGN="bottom"> <FONT SIZE="-2" COLOR= #333333 FACE="Verdana, sans-serif, Arial">Last Name </FONT> <BR> <INPUT TYPE="TEXT" NAME="LN" VALUE="" SIZE=17 MAXLENGTH=16> </TD> </TR> </TABLE> <FONT SIZE="-1" FACE="Verdana, sans-serif, Arial" COLOR="#6666ff"> <B> Address Information </B> </FONT> <TABLE BORDER="0" CELLPADDING="2" CELLSPACING="1"> <TR> <TD VALIGN="bottom"> <FONT SIZE="-2" COLOR= #333333 FACE="Verdana, sans-serif, Arial">City </FONT> <BR> <INPUT TYPE="TEXT" NAME="City" VALUE="" SIZE=15 MAXLENGTH=18> </TD> <TD VALIGN="bottom"> <FONT SIZE="-2" COLOR= #333333 FACE="Verdana, sans-serif, Arial">Country </FONT> <BR> <INPUT TYPE="TEXT" NAME="CNTRY" VALUE="" SIZE=15 MAXLENGTH=18> </TD> <TD VALIGN="bottom"> <FONT SIZE="-2" COLOR= #333333 FACE="Verdana, sans-serif, Arial">Zip </FONT> <BR> <INPUT TYPE="TEXT" NAME="ZIP" VALUE="" SIZE=9 MAXLENGTH=10> </TD> </TR> </TABLE> <TABLE BORDER="0" CELLPADDING="2" CELLSPACING="1"> <TR> <TD VALIGN="bottom"> <FONT SIZE="-2" COLOR= #333333 FACE="Verdana, sans-serif, Arial">Telephone Number </FONT> <BR> <FONT SIZE="-2" COLOR= #333333 FACE="Verdana, sans-serif, Arial"> (</FONT> <INPUT TYPE="TEXT" NAME="AC" VALUE="not" SIZE=4 MAXLENGTH=3> <FONT SIZE="-2" COLOR= #333333 FACE="Verdana, sans-serif, Arial">)- </FONT> <INPUT TYPE="TEXT" NAME="Tel" VALUE="require" SIZE=8 MAXLENGTH=8> </TD> <TD VALIGN="bottom"> <TD VALIGN="bottom"> <FONT SIZE="-2" COLOR= #333333 FACE="Verdana, sans-serif, Arial">Email Address </FONT> </FONT> <BR> <INPUT TYPE="TEXT" NAME="Eml" VALUE="your@e-mail" SIZE=12 MAXLENGTH=20> </TD> </tr> </table> <table> <tr> <td> <FONT SIZE="-2" COLOR= #333333 FACE="Verdana, sans-serif, Arial">Comments </FONT> <BR> <textarea row="3" cols="25" Name="Cmnts" wrap="virtual"> </TEXTAREA> </TD></TR> <TR> <TD bgColor=white> <P>can we contact you? <BR><INPUT name=Contact type=radio value=yes>Yes <BR><INPUT name=Contact type=radio value=No>No <BR><INPUT type=submit value=Send> <INPUT type=reset value=Reset> </P></TD></TR> <CENTER></CENTER></TBODY></TABLE></FORM>
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