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<html>
<head>
<title>Multiple Select Form Demo</title>
<link rel="stylesheet" href="style.css">
</head>
<body bgcolor="#ffffff" marginwidth=0 marginheight=0 topmargin=0 leftmargin=0 onResize="reloadPage();" class="maintext">
<p align="center"><b><font size="3">Multiple Select Form Demo</font></b></p>
<p align="center"><b>Attention:</b> Please use your valid email address. This
script will send the results of the processing to the entered email.</p>
<form name="Simple" method="post" action="/cgi-bin/formprocessorpro.pl">
<p align="center"> <font size="2">
<input type="hidden" name="base_path" value="../sample-forms/multiple-select-form">
<input type="hidden" name="rm_testselect" value="default">
<input type="hidden" name="rm_testcheckbox" value="default">
</font></p>
<table border="0" cellspacing="0" cellpadding="0" align="center">
<tr>
<td align="right" class="maintext"> </td>
<td> <font color="#FF0000">*</font> - required fields</td>
</tr>
<tr>
<td align="right" class="maintext"> </td>
<td> </td>
</tr>
<tr>
<td align="right" class="maintext"><font color="#FF0000">*</font>Name ::
</td>
<td><font size="2">
<input type="text" name="r_Name" maxlength="64" size="45" style='border: 1 outset rgb(50,50,50);'>
</font></td>
</tr>
<tr>
<td align="right" class="maintext">Company Name :: </td>
<td><font size="2">
<input type="text" name="Company-Name" maxlength="64" size="45" style='border: 1 outset rgb(50,50,50);'>
</font></td>
</tr>
<tr>
<td align="right" class="maintext"><font color="#FF0000">*</font>Contact
eMail :: </td>
<td><font size="2">
<input type="text" name="re_eMail" size="45" maxlength="64" style='border: 1 outset rgb(50,50,50);'>
</font></td>
</tr>
<tr>
<td align="right" class="maintext">Web Site URL :: </td>
<td><font size="2">
<input type="text" name="Web-Site-URL" size="45" maxlength="255" value="http://" style='border: 1 outset rgb(50,50,50);'>
</font></td>
</tr>
<tr>
<td align="right" class="maintext"><font color="#FF0000">*</font>Country
:: </td>
<td><font size="2">
<input type="text" name="r_Country" size="45" maxlength="128" style='border: 1 outset rgb(50,50,50);'>
</font></td>
</tr>
<tr>
<td align="right" class="maintext">Phone :: </td>
<td><font size="2">
<input type="text" name="Phone" size="45" maxlength="128" style='border: 1 outset rgb(50,50,50);'>
</font></td>
</tr>
<tr>
<td align="right" class="maintext">Fax :: </td>
<td><font size="2">
<input type="text" name="Fax" size="45" maxlength="128" style='border: 1 outset rgb(50,50,50);'>
</font></td>
</tr>
<tr>
<td align="right" class="maintext"> </td>
<td> </td>
</tr>
<tr>
<td align="right" class="maintext"><font color="#FF0000">*</font>Subject
::</td>
<td><font size="2">
<input type="text" name="r_Subject" size="45" maxlength="128" style='border: 1 outset rgb(50,50,50);'>
</font></td>
</tr>
<tr>
<td align="right" class="maintext"> </td>
<td> </td>
</tr>
<tr align="center">
<td class="maintext" colspan="2">
<table border="0" cellspacing="0" cellpadding="0">
<tr>
<td colspan="2" class="maintext" bgcolor="#666666"> <font color="#FF0000">*</font> <b><font color="#FFFFFF">Why
are you using the Internet?</font></b> </td>
</tr>
<tr>
<td colspan="2" align="center"><font size="2">
<select name="rm_testselect" size="10" multiple>
<option value="Business:Finance News">Business:Finance News
<option value="Chat">Chat
<option value="Coupons:Deals">Coupons:Deals
<option value="Email">Email
<option value="Entertainment News">Entertainment News
<option value="Gaming">Gaming
<option value="Health:Lifestyle">Health:Lifestyle
<option value="Job Search:Recruiting">Job Search:Recruiting
<option value="Local and National News">Local and National News
<option value="Maps:Directions">Maps:Directions
<option value="Research">Research
<option value="School:College">School:College
<option value="Shopping">Shopping
<option value="Sporting Events">Sporting Events
<option value="Sports News">Sports News
<option value="Stock Quotes">Stock Quotes
<option value="Technology News">Technology News
<option value="Travel">Travel
<option value="Weather">Weather
<option value="Other">Other
</select>
</font></td>
</tr>
</table>
</td>
</tr>
<tr>
<td align="right" class="maintext"> </td>
<td> </td>
</tr>
<tr align="center">
<td class="maintext" colspan="2">
<table border="0" cellspacing="0" cellpadding="0">
<tr>
<td colspan="2" class="maintext" bgcolor="#666666"><font color="#FF0000">*</font> <b><font color="#FFFFFF">Why
are you using the Internet?</font></b></td>
</tr>
<tr>
<td> <font size="2">
<input type="checkbox" name="rm_testcheckbox" value="Business:Finance News">
Business:Finance News </font></td>
<td> <font size="2">
<input type="checkbox" name="rm_testcheckbox" value="Chat">
Chat </font></td>
</tr>
<tr>
<td> <font size="2">
<input type="checkbox" name="rm_testcheckbox" value="Coupons:Deals ">
Coupons:Deals </font></td>
<td> <font size="2">
<input type="checkbox" name="rm_testcheckbox" value="Email ">
Email </font></td>
</tr>
<tr>
<td> <font size="2">
<input type="checkbox" name="rm_testcheckbox" value="Entertainment News">
Entertainment News </font></td>
<td> <font size="2">
<input type="checkbox" name="rm_testcheckbox" value="Gaming ">
Gaming </font></td>
</tr>
<tr>
<td> <font size="2">
<input type="checkbox" name="rm_testcheckbox" value="Health:Lifestyle ">
Health:Lifestyle </font></td>
<td> <font size="2">
<input type="checkbox" name="rm_testcheckbox" value="Job Search:Recruiting ">
Job Search:Recruiting </font></td>
</tr>
<tr>
<td> <font size="2">
<input type="checkbox" name="rm_testcheckbox" value="Local and National News ">
Local and National News </font></td>
<td> <font size="2">
<input type="checkbox" name="rm_testcheckbox" value="Maps:Directions">
Maps:Directions </font></td>
</tr>
<tr>
<td> <font size="2">
<input type="checkbox" name="rm_testcheckbox" value="Research ">
Research </font></td>
<td> <font size="2">
<input type="checkbox" name="rm_testcheckbox" value="School:College">
School:College </font></td>
</tr>
<tr>
<td> <font size="2">
<input type="checkbox" name="rm_testcheckbox" value="Shopping ">
Shopping </font></td>
<td> <font size="2">
<input type="checkbox" name="rm_testcheckbox" value="Sporting Events">
Sporting Events </font></td>
</tr>
<tr>
<td> <font size="2">
<input type="checkbox" name="rm_testcheckbox" value="Sports News ">
Sports News </font></td>
<td> <font size="2">
<input type="checkbox" name="rm_testcheckbox" value="Stock Quotes">
Stock Quotes </font></td>
</tr>
<tr>
<td> <font size="2">
<input type="checkbox" name="rm_testcheckbox" value="Technology News ">
Technology News </font></td>
<td> <font size="2">
<input type="checkbox" name="rm_testcheckbox" value="Travel">
Travel </font></td>
</tr>
<tr>
<td> <font size="2">
<input type="checkbox" name="rm_testcheckbox" value="Weather">
Weather </font></td>
<td> <font size="2">
<input type="checkbox" name="rm_testcheckbox" value="Other">
Other </font></td>
</tr>
</table>
</td>
</tr>
<tr>
<td align="right" class="maintext"> </td>
<td> </td>
</tr>
<tr align="left">
<td class="maintext" colspan="2"><font color="#FF0000">*</font>Message ::</td>
</tr>
<tr align="left">
<td class="maintext" colspan="2"><font size="2">
<textarea name="r_Message" rows="10" cols="62" wrap="VIRTUAL" class="Textarea-Style"></textarea>
</font></td>
</tr>
</table>
<div align="center">
<p><font size="2"> <br>
<input type="submit" name="Submit" value="..:: SUBMIT ::.." class="buttons">
</font></p>
</div>
</form>
</body>
</html>
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