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HTML - Order Form Help Needed...copying Fields

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Order Form Help Needed...copying Fields	View Content

firstly hello to everyone - sorry for not introducing myself prior to posting but im in DESPERATE need of help and hope someone will take pity on me and put me out my misery!!!

I am trying to include an order form in a website i am building.. i would like it to have the ability to 'copy' information from 'customers details' to 'delivery details' if these are one and the same - i have tried various things all to no avail...

here is what i have so far....

--------------------------------------------------------------------------------------------------------
<HTML>
<head>
<title></title>

<script type="text/javascript">
function data_copy()
{

if(document.form1.copy[0].checked){
document.form1."Delivery Name".value=document.form1."Customer Name".value;
document.form1."Delivery Address 1".value=document.form1."Customer Address 1".value;
document.form1."Delivery Address 2".value=document.form1."Customer Address 2".value;
document.form1."Delivery Town".value=document.form1."Customer Town".value;
document.form1."Delivery County".value=document.form1."Customer County".value;
document.form1."Delivery Post Code".value=document.form1."Customer Post Code".value;
}else{
document.form1."Delivery Name".value="";
document.form1."Delivery Address 1".value="";
document.form1."Delivery Address 2".value="";
document.form1."Delivery Town".value="";
document.form1."Delivery County".value="";
document.form1."Delivery Post Code".value="";

}

}

</script>
</head>

<form name=form1 action="">

<TABLE width="800" border="0" align="center" cellpadding="5" cellspacing="0">

<tr bgcolor="#FFFFFF">
<td width="300" align="left"><font size="2" face="Verdana"><b>Customer Details:</b></font></td>
<td width="200"></td>
<td width="200"></td>
<td width="300" align="left"><font size="2" face="Verdana"><b>Delivery Details:</b></font></td>
<td width="200"></td>
</tr>

<tr>
<td></td>
<td></td>
<td></td>
<td><input type=radio name=copy value='yes' onclick="data_copy()";><font face="Verdana" size="2">Same As Customer</font></td>
<td><input type=radio name=copy value='no' onclick="data_copy()";><font face="Verdana" size="2">Not Same</font></td>
</tr>

<tr bgcolor="#FFFFFF">
<td width="300" align="left"><font size="2" face="Verdana">Name:</font></td>
<td width="200" align="left"><input name="Customer Name" type="text" size="30"></td>
<td width="200"></td>
<td width="300" align="left"><font size="2" face="Verdana">Name:</font></td>
<td width="200" align="left"><input name="Delivery Name" type="text" size="30"></td>
</tr>

<tr bgcolor="#FFFFFF">
<td width="300" align="left"><font size="2" face="Verdana">Address 1:</font></td>
<td width="200" align="left"><input name="Customer Address 1" type="text" size="30"></td>
<td width="200"></td>
<td width="300" align="left"><font size="2" face="Verdana">Address 1:</font></td>
<td width="200" align="left"><input name="Delivery Address 1" type="text" size="30"></td>
</tr>

<tr bgcolor="#FFFFFF">
<td width="300" align="left"><font size="2" face="Verdana">Address 2:</font></td>
<td width="200" align="left"><input name="Customer Address 2" type="text" size="30"></td>
<td width="200"></td>
<td width="300" align="left"><font size="2" face="Verdana">Address 2:</font></td>
<td width="200" align="left"><input name="Delivery Address 2" type="text" size="30"></td>
</tr>

<tr bgcolor="#FFFFFF">
<td width="300" align="left"><font size="2" face="Verdana">Town:</font></td>
<td width="200" align="left"><input name="Customer Town" type="text" size="30"></td>
<td width="200"></td>
<td width="300" align="left"><font size="2" face="Verdana">Town:</font></td>
<td width="200" align="left"><input name="Delivery Town" type="text" size="30"></td>
</tr>

<tr bgcolor="#FFFFFF">
<td width="300" align="left"><font size="2" face="Verdana">County:</font></td>
<td width="200" align="left"><input name="Customer County" type="text" size="30"></td>
<td width="200"></td>
<td width="300" align="left"><font size="2" face="Verdana">County:</font></td>
<td width="200" align="left"><input name="Delivery County" type="text" size="30"></td>
</tr>

<tr bgcolor="#FFFFFF">
<td width="300" align="left"><font size="2" face="Verdana">Post Code:</font></td>
<td width="200" align="left"><input name="Customer Post Code" type="text" size="15"></td>
<td width="200"></td>
<td width="300" align="left"><font size="2" face="Verdana">Post Code:</font></td>
<td width="200" align="left"><input name="Delivery Post Code" type="text" size="15"></td>
</tr>

</table><br>

<br><input type="Submit">
</form>
</body>
--------------------------------------------------------------------------------------------------------

although it looks ok when i preview it for some reason it will not copy the information i want...

if anyone can help (and ideally explain what i am doing wrong) i would be very very thankful!

kind regards

lawrence (larryg)

Full Excel VBA Course - Beginner to Expert

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Hi everyone, below is my Paypal html order form. Im still working on the site " http://www.rjapzdesigns.com/#/order-form/4552072670 ". And I added the 5 input fields, and when the buy now is clicked, it directs to the Paypal payment page, but the information doesn't show up in my paypalaccount email. And my site is hosted by moonfruit, and their email client works works fine. I done tuns of test runs and can't find the problem. Please help if any body know what codes are missing, or needs to be changed, It's driving me nuts...

Code:

<form action="https://www.paypal.com/cgi-bin/webscr" method="post">

Company Name*:<input type="text" name="Company name" size="15"><br> 
Slogan:       <input type="text" name="Slogan" size="15"><br> 
First Name*:  <input type="text" name="First Name" size="15"><br>
Last Name*:   <input type="text" name="Last Name" size="15"><br> 
Email:        <input type="text" name="Email" size="20"><br> 

<input type="hidden" name="cmd" value="_xclick">
<input type="hidden" name="business" value="paypalaccount@rjapzdesigns.com">
<input type="hidden" name="lc" value="US">
<input type="hidden" name="item_name" value="Camping/Hiking">
<input type="hidden" name="item_number" value="Camp1front">
<input type="hidden" name="amount" value="5.00">
<input type="hidden" name="currency_code" value="USD">
<input type="hidden" name="button_subtype" value="services">
<input type="hidden" name="bn" value="PP-BuyNowBF:btn_buynowCC_LG.gif:NonHosted">

<input type="image" src="https://www.paypalobjects.com/en_US/i/btn/btn_buynowCC_LG.gif" border="0" name="submit" alt="PayPal - The safer, easier way to pay online!">

<img alt="" border="0" src="https://www.paypalobjects.com/en_US/i/scr/pixel.gif" width="1" height="1">
</form>

Robert

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I'm helping a friend build a site to sell textbooks, and the system that he's going to implement involves an "Order" page wherein you enter (or select) a five-digit class code for, say, five different classes.

What I want to know how to do is, once someone has their classes all selected and hits the "order" button, that they are given an invoice for the amount of the books needed for those classes. So, essentially, I need to figure out a way to tie each of these five-digit class codes to a certain price which will be given to the customer to complete the order right there on the site. The old model had used a method wherein a list of the classes would be sent to my friend, who would then figure the cost and call the customer back with the total.

I apologize if none of this is making sense. If not, please let me know what it is that's confusing so I may clarify.

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This form uses a wordpress plugin so it works fine but it just looks bad because it doesn't fit into the theme nicely.

Can anyone tell me how to make it fit?

Code:

http://reveretaxi.com/order-a-taxi-cab

What value do i adjust in the HTML to get it to fit?

Code:

<div align="center">
            <center>
			<pre>
            <table width="69%" height="690" cellspacing="0" cellpadding="0" border="0">
              <tbody><tr>
                <td width="50%" height="25" bgcolor="#ff0000" align="right">      </td>
                <td width="50%" height="25" bgcolor="#ff0000"> </td>
              </tr>
              <tr>
                <td width="50%" height="25" align="right"><b><font size="5" color="#000000">*</font><font color="#000000">Leaving
                  From</font></b></td>
                <td width="50%" height="25">
				<!--webbot bot="Validation" b-value-required="TRUE" -->[text* LeavingFrom]</td>
              </tr>
              <tr>
                <td width="50%" height="25" align="right"><b><font size="5" color="#000000">*</font></b><font color="#000000"><b>Cross-Street:</b></font></td>
                <td width="50%" height="25">
				<!--webbot bot="Validation" b-value-required="TRUE" -->[text* Cross-Street:]</td>
              </tr>
              <tr>
                <td width="50%" height="25" align="right"><b><font size="5" color="#000000">*</font></b><font color="#000000"><b>Location
                  Type:</b></font></td>
                <td width="50%" height="25">
				<!--webbot bot="Validation" b-value-required="TRUE" -->[select* LocationType: "Choose One" "House" "Business" "Apartment" "Other"]</td>
              </tr>
              <tr>
                <td width="50%" height="25" align="right"><b><font size="5" color="#000000">*</font></b><font color="#000000"><b>City:</b></font></td>
                <td width="50%" height="25">
				<!--webbot bot="Validation" b-value-required="TRUE" -->[text* LeavingFromCity]</td>
              </tr>
              <tr>
                <td width="50%" height="25" align="right"><b><font size="5" color="#000000">*</font></b><font color="#000000"><b>State:</b></font></td>
                <td width="50%" height="25">
				<!--webbot bot="Validation" b-value-required="TRUE" -->[text* LeavingFromState]</td>
              </tr>
              <tr>
                <td width="50%" height="25" align="right"><b><font size="5" color="#000000">*</font></b><font color="#000000"><b>Date:</b></font></td>
                <td width="50%" height="25">
				<!--webbot bot="Validation" b-value-required="TRUE" -->[text* Date]</td>
              </tr>
              <tr>
                <td width="50%" height="25" align="right"><b><font size="5" color="#000000">*</font></b><font color="#000000"><b>Time:</b></font></td>
                <td width="50%" height="25">
				<!--webbot bot="Validation" b-value-required="TRUE" -->[select* Hour "Hour" "1" "2" "3" "4" "5" "6" "7" "8" "9" "10" "11" "12"]<!--webbot bot="Validation" b-value-required="TRUE" -->[select* Minute "05" "10" "15" "20" "25" "30" "35" "40" "45" "50" "55" "00"]<!--webbot bot="Validation" b-value-required="TRUE" -->[select* AMorPM "AM" "PM"]</td>
              </tr>
              <tr>
                <td width="50%" height="21" bgcolor="#ff0000">   </td>
                <td width="50%" height="21" bgcolor="#ff0000"> </td>
              </tr>
              <tr>
                <td width="50%" height="25" align="right"><b><font size="5" color="#000000">*</font><font color="#000000">Destination:</font></b></td>
                <td width="50%" height="25">
				<!--webbot bot="Validation" b-value-required="TRUE" -->[text* Destination]</td>
              </tr>
              <tr>
                <td width="50%" height="25" align="right"><b><font size="5" color="#000000">*</font></b><font color="#000000"><b>City:</b></font></td>
                <td width="50%" height="25">
				<!--webbot bot="Validation" b-value-required="TRUE" -->[text* DestinationCity]</td>
              </tr>
              <tr>
                <td width="50%" height="26" align="right"><b><font size="5" color="#000000">*</font></b><font color="#000000"><b>State:</b></font></td>
                <td width="50%" height="26">
				<!--webbot bot="Validation" b-value-required="TRUE" -->[text* DestinationState]</td>
              </tr>
              <tr>
                <td width="50%" height="21" bgcolor="#ff0000" align="right">  </td>
                <td width="50%" height="21" bgcolor="#ff0000"> </td>
              </tr>
              <tr>
                <td width="50%" height="25" align="right"><b><font size="5" color="#000000">*</font></b><font color="#000000"><b>Vehicle
                  Type Preference:</b></font></td>
                <td width="50%" height="25">
				<!--webbot bot="Validation" b-value-required="TRUE" -->[select* VehicleTypePreference "Taxi - 4 Door preferred" "Taxi - Van preferred"]</td>
              </tr>
              <tr>
                <td width="50%" height="25" align="right"><b><font size="5" color="#000000">*</font></b><font color="#000000"><b>Payment
                  Type:</b></font></td>
                <td width="50%" height="25">
				<!--webbot bot="Validation" b-value-required="TRUE" -->[select* PaymentType "Choose One" "Cash" "Visa" "Master Card" "American Express" "Voucher"]</td>
              </tr>
              <tr>
                <td width="50%" height="25" align="right"><font color="#000000"><b>Number
                  of Passengers:</b></font></td>
                <td width="50%" height="25">[select NumberofPassengers "1" "2" "3" "4" "5" "6" "7" "8" "9" "10"]</td>
              </tr>
              <tr>
                <td width="50%" height="21" bgcolor="#ff0000" align="right"></td>
                <td width="50%" height="21" bgcolor="#ff0000"></td>
              </tr>
              <tr>
                <td width="50%" height="25" align="right"><b><font size="5" color="#000000">*</font></b><font color="#000000"><b>Contact
                  Name:</b></font></td>
                <td width="50%" height="25">
				<!--webbot bot="Validation" b-value-required="TRUE" -->[text* ContactName]</td>
              </tr>
              <tr>
                <td width="50%" height="25" align="right"><b><font size="5" color="#000000">*</font></b><font color="#000000"><b>Contact
                  Phone Number<br>
                  (w/ Area Code):</b></font></td>
                <td width="50%" height="25">
				<!--webbot bot="Validation" b-value-required="TRUE" -->[text* ContactPhoneNumber]</td>
              </tr>
              <tr>
                <td width="50%" height="25" align="right"><b><font size="5" color="#000000">*</font></b><font color="#000000"><b>Contact
                  Email:</b></font></td>
                <td width="50%" height="25">
				<!--webbot bot="Validation" b-value-required="TRUE" -->[text* ContactEmail]</td>
              </tr>
              <tr>
                <td width="50%" height="21" bgcolor="#ff0000" align="right">    </td>
                <td width="50%" height="21" bgcolor="#ff0000"> </td>
              </tr>
              <tr>
                <td height="59" align="right" colspan="2">
                  <p align="center"><b><font color="#000000">If
                  you require service to meet an arriving flight, please provide
                  the following:</font></b></p>
                </td>
              
              </tr>
              <tr>
                <td width="50%" height="25" align="right"><font color="#000000"><b>Airline:</b></font></td>
                <td width="50%" height="25">[text Airline]</td>
              </tr>
              <tr>
                <td width="50%" height="25" align="right"><font color="#000000"><b>Flight
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                <td width="50%" height="25">[text FlightNumber]</td>
              </tr>
              <tr>
                <td width="50%" height="21" bgcolor="#ff0000" align="right">         </td>
                <td width="50%" height="21" bgcolor="#ff0000"> </td>
              </tr>
              <tr>
                <td height="40" align="right" colspan="2">
                  <p align="center"><b><font color="#000000">If
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                </td>
            
              </tr>
              <tr>
                <td width="50%" height="25" align="right"><font color="#000000"><b>Voucher
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                <td width="50%" height="25">[text VoucherAccountName]</td>
              </tr>
              <tr>
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                <td width="50%" height="25">[text VoucherAccountNumber]</td>
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              <tr>
                <td width="50%" height="25" bgcolor="#ff0000" align="right">      </td>
                <td width="50%" height="25" bgcolor="#ff0000"> </td>
              </tr>
            </tbody></table>
			</pre>
            </center>
          </div>


          <p align="center"><font color="#000000"><b>Please provide any special
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I'm trying to do a simple online form that emails me the results from a few fields.

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Code:

<form action="http://cm1web1/WebSurveyComponents/script/processform.asp" method="post">

<!-- Mandatory "hidden" objects -->
<p>
  <input type="hidden" name="strInputElements" readonly value="Suggestion">
  <input type="hidden" name="strInputElements" value="Name">
  <input type="hidden" name="strInputElements" value="Email">
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Suggestion Box">
		  
Name:
<input type=text name="Name">
<br>(optional, but required if you would like a response to your comments or suggestions)</p>
<p>Email: 
  <input type=text name="Email"> 
  <br>(optional)
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<p>Business unit: 
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    <br>
    <br>
    <input name="Send" type="submit" value="Send">
&nbsp;&nbsp;&nbsp;
    <input name="Clear" type="reset" value="Clear">
</p>
<p>(Unless you fill in your name and/or email, this form is completely anonymous)</p>
</form>

And the email I receive looks like this...

Field = Suggestion
Response = Write your feedback or suggestion here

Field = Name
Response =

Field = Email
Response =

Field = Business Unit
Response =

The "Suggestion" field works fine, but the Name, Email and Business Unit fields all come through with blank responses.

Any ideas?

Thanks!
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I've honest to god looked for 2 days for tutorials and pre set up scripts for this but cannot understand any of it. could someone please make all of my friends required, except for the radio buttons. i just need at least one of them selected.

id really appreciate it. thank you.

Quote:

<form name="_xclick" action="https://www.paypal.com/us/cgi-bin/webscr" onSubmit="return emailCheck()" method="post">
<input type="hidden" name="cmd" value="_xclick">
<input type="hidden" name="business" value="boxer_347@yahoo.com">
<input type="hidden" name="currency_code" value="USD">
<input type="hidden" name="item_name" value="Personal Plan">

<center>
<table>
<tr>
<td>
<input type="hidden" name="on1" value="name"><font size="2"><b>First Name:</b></font></td>
<td>
<input type="text" name="os1" maxlength="200"><font size="2" color="#666666"><br>(Your first name)<br><br></font></td>
</tr>

<tr>
<td>
<input type="hidden" name="on1" value="account"><font size="2"><b>Account Name:</b></font></td>
<td>
<input type="text" name="os1" maxlength="200"><font size="2" color="#666666"><br>(Register a cPanel username)<br><br></font></td>
</tr>

<tr>
<td>
<input type="hidden" name="on1" value="password"><font size="2"><b>Password:</b></font></td>
<td>
<input type="password" name="os1" maxlength="200"><font size="2" color="#666666"><br>(Register a cPanel password)<br><br></font></td>
</tr>

<tr>
<td>
<input type="hidden" name="on1" value="email"><font size="2"><b>Email Address:</b></font></td>
<td>
<input type="text" name="os1" maxlength="200"><font size="2" color="#666666"><br>(Email address we can contact you at)<br><br></font></td>
</tr>

<tr>
<td>
<input type="hidden" name="on1" value="domain"><font size="2"><b>Domain:</b></font></td>
<td>
<input type="text" name="os1" maxlength="200"><font size="2"> (Optional)</font><br><font size="2" color="#666666">(Domain you wish to link to us)</font></td>
</tr>
</table>
</center>

<br>

<center>
<table>

<tr>
<td>

<input type="radio" name="amount" value="1.00"><b>1 Month - $1.00</b>
</td>
</tr>

<tr>
<td>

<input type="radio" name="amount" value="2.70"><b>3 Months $2.70 (Save 10%)</b>
</td>
</tr>

<tr>
<td>

<input type="radio" name="amount" value="4.92"><b>6 Months - $4.92 (Save 18%)</b>
</td>
</tr>

<tr>
<td>

<input type="radio" name="amount" value="9.00"><b>1 Year - $9.00 (Save 25%)</b>
</td>
</tr>
</table>
</center>

<center>
<br>
<table>
<tr>
<td>
<input type="checkbox" name="agree" value="tos"> I agree to the <a STYLE="text-decoration:none" href="tos.html"><font size="2" color="#3999FF">Terms of Service</font></a>
</td>
</tr>
</table>

<br>
<table>
<tr>
<td>
<input type="image" src="https://www.paypalobjects.com/WEBSCR-480-20070831-2/en_US/i/btn/btn_buynowCC_LG.gif" style="float:right;" border="0" name="submit">
</td></tr>
</table>
</center>
</form>

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I am trying to amend an existing form so that some fields are mandatory.

So far this is what I've have on the script right before </head> tag:

Code:

<script type="text/javascript">
function checkForm(frm){
msg = "";
   if(!frm.name.value){
      msg += "- Name is required\n";
   }
   if(!frm.phone.value){
      msg += "- Phone is required\n";
   }
   if(!frm.email.value){
      msg += "- Email is required\n";
   }
   
   if(msg != ""){
      alert(msg);
      return false;
   }
}
</script>

and on at the begining of the form itself I have:
Code:

<form id="form1" name="form1" method="post" action="contact1.php" onsubmit="return checkForm(this)">
   <input type="text" name="name" id="name"><br>
   <input type="text" name="email" id="email" style="margin-top:3px "><br>
    <input type="text" name="phone" id="phone" style="margin-top:3px "><br>

But when I get the form back on my test email all the fields are empty!

Here here my contact.php:

PHP Code:
<?
$subject="Booking Table from ".$_GET['name'] ;
$headers= "From: ".$_GET['email']."\n";
$headers.='Content-type: text/html; charset=iso-8859-1';
mail("contactatalexotero.co.uk", $subject,  "
<html>
<head>
<title>Book Table</title>
</head>
<body>

<br>Phone Number
  ".$_GET['phone']."
<br>Number of people
  ".$_GET['people']."
<br>Where?
  ".$_GET['where']."
<br>Time
  ".$_GET['time']."
  <br>Date
  ".$_GET['day']."/
  ".$_GET['month']."/
  ".$_GET['year']."
  <br>Message
  ".$_GET['message']."
</body>
</html>" , $headers);
echo ("Your message was successfully sent! We will contact you shortly to confirm your table!");
?>
<script>
     window.close
</script>

What do I do wrong? Please help me

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My first thought was to somehow disable the "Back" button but that is probably offensive to many, and I wouldn't want to alienate anyone.

Maybe someone on this forum might have the answer to my question or may be able to suggest another approch I could use.

Thanking you in advance,
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I dont verify these fields currently but wish to do so. I merely have them sent to feedback.php which accepts the data and sends the emails.

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2, I want a simple captcha that can also be verified on contactus.php itself.

Can someone help?
Thanks
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After putting all information in the Form, when I submit, new window opens and different Error Messege:
Error: Blank Fields
The following fields were left blank in your submission form:

email
your_name

These fields must be filled in before you can successfully submit the form.
Please use your browser's back button to return to the form and try again.

I checked, all fields.. non of them is empty... Pls any one can help me to fix,
Here are codes:

<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">
<html>

<head>
<meta http-equiv="content-type" content="text/html;charset=iso-8859-1">
<meta name="generator" content="Adobe GoLive">
<title>Assessment Form</title>
</head>

<body bgcolor="#ffffff">
<p>
<TABLE BORDER="0" CELLSPACING="0" CELLPADDING="4" WIDTH="90%">
<TR>
<form method=POST action="http://www.supremelegal.com/cgi-bin/formmail.pl" target="_top">
<INPUT TYPE="HIDDEN" NAME="recipient" VALUE="atharatsupremelegal.com">
<INPUT TYPE="HIDDEN" NAME="subject" VALUE="WebSite Contact">
<INPUT TYPE="HIDDEN" NAME="redirect" VALUE="http://www.supremelegal.com/thanks.htm">
<INPUT TYPE="HIDDEN" NAME="required" VALUE="email.com,your_name">
<input type=hidden name="sort" value="through,your_name,phone,company_name,email,comments">
<TD width="30%"><DIV align="right">
<B>Fist Name:</B>
</DIV>
</TD>
<TD width="70%">
<INPUT type="text" name="Fist Name" size="40">
</TD>
</TR>
<TR>
<TD width="30%"><DIV align="right">
<B>Last Name:</B>
</DIV>
</TD>
<TD width="70%">
<INPUT type="text" name="Last Name" size="40">
</TD>
</TR>
<TR>
<TD width="30%"><DIV align="right">
<B>Address:</B>
</DIV>
</TD>
<TD width="70%">
<INPUT type="text" name="Address:" size="40">
</TD>
</TR>
<TR>
<TD width="30%"><DIV align="right">
<B>City:</B>
</DIV>
</TD>
<TD width="70%">
<INPUT type="text" name="City:" size="40">
</TD>
</TR>
<TR>
<TD width="30%"><DIV align="right">
<B>State/Province:</B>
</DIV>
</TD>
<TD width="70%">
<INPUT type="text" name="State/Province:" size="40">
</TD>
</TR>
<TR>
<TD width="30%"><DIV align="right">
<B>Zip code & Country:</B>
</DIV>
</TD>
<TD width="70%">
<INPUT type="text" name="Zip code & Country:" size="40">
</TD>
</TR>
<TR>
<TD width="30%"><DIV align="right">
<B>Nationality:</B>
</DIV>
</TD>
<TD width="70%">
<INPUT type="text" name="Nationality:" size="40">
</TD>
</TR>
<TR>
<TD width="30%"><DIV align="right">
<B>Date of Birth:</B>
</DIV>
</TD>
<TD width="70%">
<INPUT type="text" name="Date of Birth:" size="40">
</TD>
</TR>

<TR>
<TD width="30%"><DIV align="right">
<B>E-mail Address:</B>
</DIV>
</TD>
<TD width="70%">
<INPUT type="text" name="E-mail Address:" size="40">
</TD>
</TR>
<TR>
<TD width="30%"><DIV align="right">
<B>Highest Level of education:</B>
</DIV>
</TD>
<TD width="70%">
<INPUT type="text" name="Highest Level of education:" size="40">
</TD>
</TR>
<TR>
<TD width="30%"><DIV align="right">
<B>Total years of education:</B>
</DIV>
</TD>
<TD width="70%">
<INPUT type="text" name="Total years of education:" size="40">
</TD>
</TR>
<TR>
<TD width="30%"><DIV align="right">
<B>Current occupation:</B>
</DIV>
</TD>
<TD width="70%">
<INPUT type="text" name="Current occupation:" size="40">
</TD>
</TR>
<TR>
<TD width="30%"><DIV align="right">
<B>Total years of full paid work experiance:</B>
</DIV>
</TD>
<TD width="70%">
<INPUT type="text" name="Total years of full paid work experiance:" size="40">
</TD>
</TR>
<TR>
<TD width="30%"><DIV align="right">
<B>English Language Proficiency:</B>
</DIV>
</TD>
<TD width="70%">
<INPUT type="text" name="English Language Proficiency:" size="40">
</TD>
</TR>
<TR><td width="1%"></td>
<TD colspan="2">
<p><font size="1" face="Verdana, Arial, Helvetica, sans-serif"><input type="checkbox"
name="option1" value="High"> High<br>
<input type="checkbox" name="option2" value="Moderate"> Moderate<br>
</font>
</TD></TR>

<TR>
<TD width="30%"><DIV align="right">
<B>French Language Proficiency:</B>
</DIV>
</TD>
<TD width="70%">
<INPUT type="text" name="French Language Proficiency:" size="40">
</TD>
</TR>
<TR><td width="1%"></td>
<TD colspan="2">
<p><font size="1" face="Verdana, Arial, Helvetica, sans-serif"><input type="checkbox"
name="option1" value="High"> High<br>
<input type="checkbox" name="option2" value="Moderate"> Moderate<br>
</font>
</TD>
</TR>

<TR>
<TD width="30%"><DIV align="right">
<B>Marital Status:</B>
</DIV>
</TD>
<TD width="70%">
<INPUT type="text" name="Marital Status:" size="40">
</TD>
</TR>

<TR>
<TD width="30%"><DIV align="right">
<B>Name, age, qualification, work experiance of your partner:</B>
</DIV>
</TD>
<TD width="70%">
<INPUT type="text" name="Name, age, qualification, work experiance of your partner:" size="40">
</TD>
</TR>

<TR>
<TD width="30%"><DIV align="right">
<B>You or your partner ever worked or studied in Canada:</B>
</DIV>
</TD>
<TD width="70%">
<INPUT type="text" name="You or your partner ever worked or studied in Canada:" size="20">
</TD>
</TR>

<TR>
<TD width="30%"><DIV align="right">
<B>You or your partner have any relative willing to sponsor you in Canada:</B>
</DIV>
</TD>
<TD width="70%">
<INPUT type="text" name="You or your partner have any relative willing to sponsor you in Canada:" size="20">
</TD>
</TR>

<TR>
<TD width="30%"><DIV align="right">
<B>What is their legal status in Canada:</B>
</DIV>
</TD>
<TD width="70%">
<INPUT type="text" name="What is their legal status in Canada:" size="20">
</TD>
</TR>

<TR>
<TD width="30%"><DIV align="right">
<B>Any Employer in Canada willing to sponsor you, Full Name & Address:</B>
</DIV>
</TD>
<TD width="70%">
<INPUT type="text" name="Any Employer in Canada willing to sponsor you, Full Name & Address:" size="20">
</TD>
</TR>

<TR>
<TD width="30%"><DIV align="right">
<B>Do you or your partner plan to invest funds in Canada:</B>
</DIV>
</TD>
<TD width="70%">
<INPUT type="text" name="Do you or your partner plan to invest funds in Canada:" size="20">
</TD>
</TR>
<TR>
<TD width="30%"><DIV align="right">
<B>Upon immigration how much (CAD$)funds can you show:</B>
</DIV>
</TD>
<TD width="70%">
<INPUT type="text" name="Upon immigration how much (CAD$)funds can you show:" size="20">
</TD>
</TR>
<TR>
<TD>
<DIV align="right"><B>How did you hear about us:</B></DIV>
</TD>
<TD>
<INPUT type="text" name="email" size="20">
</TD>
</TR>
<TR>
<TD>
<DIV align="right">
<B>If you have any question or comments:</B>
</DIV>
</TD>
<TD>
<TEXTAREA name="comment" cols="30" wrap="virtual"rows="4">
Here is my comment...
</TEXTAREA>
</TD></TR>
<TR>
<TD> </TD>
<TD>
<INPUT type="submit" name="submit"
value="Submit">
<INPUT type="reset" name="reset" value="Reset">
</TD></TR>
</TABLE>
</FORM></p>
</body>

</html>

Script is he http://www.supremelegal.com/test.html ( script is in cgi-bin folder and safe in formmail.pl format NOT html, it is only to show you guys).... {www/cgi-bin/formmail.pl } ...... thank you in advance..