home *** CD-ROM | disk | FTP | other *** search
/ PC World 1999 April / PCWorld_1999-04_cd.bin / Software / TemaCD / DutchHtm / Feedback.dt_ / Feedback.dt
INI File  |  1998-12-01  |  1KB  |  55 lines
  1. [Do not delete or edit this document]
  2. <HTML>
  3. <HEAD>
  4. <TITLE> FEEDBACK FORM </TITLE>
  5. </HEAD>
  6. <BODY>
  7.  
  8. <CENTER><H3><FONT SIZE=6 COLOR=#0000FF><B>FEEDBACK FORM</B></FONT></H3></CENTER>
  9.  
  10. <CENTER><TABLE WIDTH=600><TR><TD>
  11.  
  12. <BLOCKQUOTE><STRONG>KeyWord</STRONG></BLOCKQUOTE>
  13.  
  14. <FORM METHOD=POST ACTION=KeyWord>
  15. <STRONG>What type of message would you like to send?</STRONG> 
  16. <SELECT NAME="message_type" VALUE="Suggestion" size=1 maxlength=20>
  17. <OPTION>Praise
  18. <OPTION>Problem
  19. <OPTION>Complaint
  20. <OPTION>Suggestion    
  21. </SELECT>
  22. <p>
  23. <STRONG>Please enter your comments in the space below:</STRONG><BR>
  24. <TEXTAREA NAME="comments" ROWS=10 COLS=70></TEXTAREA><BR><p>
  25. <STRONG>Please, tell us how to contact you:</STRONG>
  26. <TABLE><TR><TD>
  27. <STRONG>Your Name:</STRONG></TD>
  28. <TD><INPUT NAME="name" TYPE="" SIZE="30"></TD></TR>
  29.  
  30. <TR><TD>
  31. <STRONG>Your E-Mail Address:</STRONG>
  32. </TD>
  33. <TD><INPUT NAME="email" TYPE="" SIZE="30"></TD></TR>
  34. <TR><TD>
  35. <STRONG>Your Phone Number:</STRONG>
  36. </TD>
  37. <TD><INPUT NAME="phone" TYPE="" SIZE="30"></TD></TR>
  38. <TR><TD>
  39. <STRONG>Your Fax Number:</STRONG>
  40. </TD>
  41. <TD><INPUT NAME="fax" TYPE="" SIZE="30">
  42. </TD></TR>
  43. <TR><TD>
  44. <INPUT  TYPE="SUBMIT">
  45. <INPUT  TYPE="RESET">
  46. </TD></TR>
  47.  
  48. </TABLE>
  49. </FORM>
  50.  
  51. </TD></TR></TABLE></CENTER>
  52.  
  53. </BODY>
  54. </HTML>
  55.