How can I add a survey form to an EZ page?

I need to add a survey form to an EZ page. I'm setting up a local sales campaign and in order to do that I need my customers to answer a short survey first to help me select a local charity to donate a portion of the campaign's proceeds to.

But when I tried to set up a form it essentially wiped out the right hand column along with a few other problems. :frusty: And my radio buttons don't exclude each other. Only one choice is to be allowed or a write-in option along with a comments section

So how do I do this? Help me please. I'm not a PHP guru.

This is essentially a squeeze page that I want to send a limited number of people to or rather a geographically limited number of people. For now it is linked from the home page but I will remove the link when it is fixed and just send local people to it. And yes there will be glove and gardening products information for people to shop from uploaded shortly

Here's the page:http://katzgardengloves.com/index.php?main_page=page&id=4&chapter=0

As far as I know, I don't think you can easily include a survey form to an EZ page. EZ pages are usually used for telling customers information or articles...

Perhaps you can use other survey modules and put a link somewhere say in the sidebox. Hope this helps. Good luck.

you can use "http://www.surveygizmo.com/ " and embed it