<html> <head><title>Example Form 3</title></head> <body bgcolor="#3c8484"> <center> <img src="/tools/enhance/form_emailer_help/example3/dctitle.gif" border="0"> </center> <h1>Order Form</h1>
<form action="/cgi-bin/cgiemail" method="post">
<!-- HTML Template used for the page after successful submission --> <input type="hidden" name="cgiemail_html" value="thank_you.html">
<!-- HTML Template used in case as error occurs --> <input type="hidden" name="cgiemail_error" value="error.html">
<!-- Customized Error message for bad Email addresses --> <input type="hidden" name="cgiemail_invalid" value="You typed your email wrong.">
<!-- Message Template for the email message that gets sent --> <input type="hidden" name="cgiemail_message" value="message1.txt">
<!-- I prefer the date for this email to be sent in Pacific Standard Time--> <input type="hidden" name="cgiemail_timezone" value="PST">
<!-- TIME Shown in the format "Wednesday, February 17, 1999 18:46:41"--> <input type="hidden" name="cgiemail_timeformat" value="%A,%B %e, %Y %T">
<!-- Delimitor to be used for the "product" variable below --> <input type="hidden" name="delim_product" value=";">
<!-- Fields that must be submitted --> <input type="hidden" name="cgiemail_required" value="product:You need to select at least one Item, or you are not going to order anything."> <input type="hidden" name="cgiemail_required" value="full_name:Please supply your full name."> <input type="hidden" name="cgiemail_required" value="email:You forgot to put your email address."> <input type="hidden" name="cgiemail_required" value="phone:Your voice phone number is required."> <input type="hidden" name="cgiemail_required" value="address1:Please supply your snail mail addres."> <input type="hidden" name="cgiemail_required" value="city:Your city is is required."> <input type="hidden" name="cgiemail_required" value="state:Please enter your TWO DIGIT state code."> <input type="hidden" name="cgiemail_required" value="zip:Mailing ZIPCODE is required.">
<table border="1"> <tr><td colspan="2"><b>Send me the following Items:</b><br> <input type="checkbox" name="product" value="PRODUCT1">Item #1 <input type="checkbox" name="product" value="PRODUCT2">Item #2 <input type="checkbox" name="product" value="PRODUCT3">Item #3</td></tr> <tr><td><b>Email:</b></td> <td><input name="email"></td></tr> <tr><td><b>Full Name:</b></td> <td><input name="full_name"></td></tr> <tr><td><b>Company:</b></td> <td><input name="company"></td></tr> <tr><td><b>Address1:</b></td> <td><input name="address1"></td></tr> <tr><td><b>Address2:</b></td> <td><input name="address2"></td></tr> <tr><td><b>City/State/ZIP:</b></td> <td><input name="city" size="10"><input name="state" size="2" maxlength="2"><input name="zip" size="5"></td></tr> <tr><td><b>Phone Number:</b></td> <td><input name="phone"></td></tr> <tr><td colspan=2><b>Optional Additional Instructions:</b><br><textarea rows="3" cols="60" name="instructions"></textarea></td></tr> <tr><td colspan=2><input type="submit" value="SUBMIT TEST ORDER"></td></tr> </table>
</form>
</body> </html>