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1 <!DOCTYPE html> | |
2 <html> | |
3 <head> | |
4 <meta charset="UTF-8"> | |
5 <title></title> | |
6 </head> | |
7 <body> | |
8 <form action="http://www.google.com/" method="post"> | |
9 <label for="firstname">First name:</label> | |
10 <input type="text" id="firstname"><br/> | |
11 <label for="lastname">Last name:</label> | |
12 <input type="text" id="lastname"><br/> | |
13 <label for="address">Address:</label> | |
14 <input type="text" id="address"><br/> | |
15 <label for="city">City:</label> | |
16 <input type="text" id="city"><br/> | |
17 <label for="state">State:</label> | |
18 <input type="text" id="state"><br/> | |
19 <label for="zip">Zip:</label> | |
20 <input type="text" id="zip"><br/> | |
21 | |
22 <label for="phone">Phone:</label> | |
23 <input type="text" id="phone"><br/> | |
24 Area Code: <input type="text" id="areacode1"> | |
25 Phone: <input type="text" id="phone1"><br/> | |
26 Phone: | |
27 <input type="text" maxlength="3" name="hphone1"> | |
28 - <input type="text" maxlength="3" name="hphone2"> | |
29 - <input type="text" maxlength="4" name="hphone3"> | |
30 ext.: <input type="text" maxlength="5" name="hphone4"><br/> | |
31 Phone: | |
32 ( <input type="text" maxlength="3" name="hphone1a"> ) | |
33 <input type="text" maxlength="3" name="hphone2a"> | |
34 - <input type="text" maxlength="4" name="hphone3a"> | |
35 ext.: <input type="text" maxlength="5" name="hphone4a"><br/> | |
36 Phone: | |
37 <input type="text" maxlength="2" name="hphone1b"> | |
38 <input type="text" maxlength="3" name="hphone1b"> | |
39 - <input type="text" maxlength="3" name="hphone2b"> | |
40 - <input type="text" maxlength="4" name="hphone3b"> | |
41 ext.: <input type="text" maxlength="5" name="hphone4b"><br/> | |
42 Phone: | |
43 <input type="text" maxlength="2" name="hphone1c"> | |
44 ( <input type="text" maxlength="3" name="hphone1c"> ) | |
45 <input type="text" maxlength="3" name="hphone2c"> | |
46 - <input type="text" maxlength="4" name="hphone3c"> | |
47 ext.: <input type="text" maxlength="5" name="hphone4c"><br/> | |
48 | |
49 Fax: <input type="text" id="fax"><br/> | |
50 Area Code: <input type="text" id="faxareacode1"> | |
51 Fax: <input type="text" id="fax1"><br/> | |
52 Fax: | |
53 <input type="text" maxlength="3" name="hfax1"> | |
54 - <input type="text" maxlength="3" name="hfax2"> | |
55 - <input type="text" maxlength="4" name="hfax3"> | |
56 ext.: <input type="text" maxlength="5" name="hfax4"><br/> | |
57 Fax: | |
58 ( <input type="text" maxlength="3" name="hfax1a"> ) | |
59 <input type="text" maxlength="3" name="hfax2a"> | |
60 - <input type="text" maxlength="4" name="hfax3a"> | |
61 ext.: <input type="text" maxlength="5" name="hfax4a"><br/> | |
62 Fax: | |
63 <input type="text" maxlength="2" name="hfax0b"> | |
64 <input type="text" maxlength="3" name="hfax1b"> | |
65 - <input type="text" maxlength="3" name="hfax2b"> | |
66 - <input type="text" maxlength="4" name="hfax3b"> | |
67 ext.: <input type="text" maxlength="5" name="hfax4"><br/> | |
68 Fax: <input type="text" maxlength="2" name="hfax0c"> | |
69 ( <input type="text" maxlength="3" name="hfax1c"> ) | |
70 <input type="text" maxlength="3" name="hfax2c"> | |
71 - <input type="text" maxlength="4" name="hfax3c"> | |
72 ext.: <input type="text" maxlength="5" name="hfax4c"><br/> | |
73 </form> | |
74 </body> | |
75 </html> | |
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