Pusat Aktiviti KRT Bandar Baru Pasir Pekan

Pusat Aktiviti KRT Bandar Baru Pasir Pekan
KRTBBPP

14 June, 2011

Form script

<---

<form name="htmlform" method="post" action="html_form_send.php">
<table width="450px">
</tr>
<tr>
 <td valign="top">
  <label for="first_name">First Name *</label>
 </td>
 <td valign="top">
  <input  type="text" name="first_name" maxlength="50" size="30">
 </td>
</tr>

<tr>
 <td valign="top"">
  <label for="last_name">Last Name *</label>
 </td>
 <td valign="top">
  <input  type="text" name="last_name" maxlength="50" size="30">
 </td>
</tr>
<tr>
 <td valign="top">
  <label for="email">Email Address *</label>
 </td>
 <td valign="top">
  <input  type="text" name="email" maxlength="80" size="30">
 </td>

</tr>
<tr>
 <td valign="top">
  <label for="telephone">Telephone Number</label>
 </td>
 <td valign="top">
  <input  type="text" name="telephone" maxlength="30" size="30">
 </td>
</tr>
<tr>
 <td valign="top">
  <label for="comments">Comments *</label>
 </td>
 <td valign="top">
  <textarea  name="comments" maxlength="1000" cols="25" rows="6"></textarea>
 </td>

</tr>
<tr>
 <td colspan="2" style="text-align:center">
  <input type="submit" value="Submit">
 </td>
</tr>
</table>
</form>


-->

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