<form name="feedback_form" action="cgi-bin/formMail.cgi" method="post">
<p>
<font size="2"> Problems or suggestions?<br/>
Your comments are appreciated.<br/>
<br/>
Fields indicated <font color="#FF0000">*</font> are required </font></p>
<table border="0" cellpadding="0" cellspacing="0" style="border-collapse: collapse" bordercolor="#111111" width="356">
<input type="hidden" name="recipient" value="
[email protected]" />
<input type="hidden" name="subject" value="Feedback from CropinStop website" />
<input type="hidden" name="required" value="zipcode,fbsubject,feedback" />
<tr>
<td width="93" align="right" style="height: 21px">Name: </td>
<td width="259" style="height: 21px">
<input type="text" name="cname" size="45" />
</td>
</tr>
<tr>
<td width="93" align="right">Email: </td>
<td width="259">
<input type="text" name="cmail" size="45" />
</td>
</tr>
<tr>
<td width="94" align="right"><font color="#FF0000">*</font> Zip Code: </td>
<td width="259">
<input type="text" name="zipcode" size="12"/>
</td>
</tr>
<tr>
<td width="94" align="right"><font color="#FF0000">*</font> Subject: </td>
<td width="259">
<input type="text" name="fbsubject" size="45" />
</td>
</tr>
<tr>
<td width="94" align="left"><font color="#FF0000">*</font> Message:</td>
<td width="259"> </td>
</tr>
</table>
<textarea name="feedback" cols="27" rows="7">
</textarea>
<input type="image"
src="includes/templates/sophyblue/buttons/english/button_send.gif"
alt="Send Now" title=" Send Now " width="49" height="24" name="I1" onclick="submit"/>
</form>
Bookmarks