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<html>
<head>
<title>Checkout 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">Checkout 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">
<input type="hidden" name="base_path" value="../sample-forms/checkout-form">
<input type="hidden" name="Procuct1-Price" value="12">
<input type="hidden" name="Procuct2-Price" value="25">
<input type="hidden" name="Procuct3-Price" value="50">
</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="30" 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="30" 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="30" maxlength="64" style='border: 1 outset rgb(50,50,50);'>
</font></td>
</tr>
<tr>
<td align="right" class="maintext"> </td>
<td> </td>
</tr>
<tr align="left">
<td class="maintext" colspan="2"><font color="#FF0000">*</font>Please choose
products that you would like to purchase ::</td>
</tr>
<tr>
<td align="right" class="maintext"> </td>
<td> </td>
</tr>
<tr>
<td align="right" class="maintext" colspan="2">
<table border="0" cellspacing="0" cellpadding="0" width="100%">
<tr bgcolor="#666666">
<td class="maintext" nowrap><b><font color="#FFFFFF">Product Name</font></b></td>
<td class="maintext" nowrap><b><font color="#FFFFFF">Price Per Unit
</font></b></td>
<td class="maintext" nowrap><b><font color="#FFFFFF">Quantity</font></b></td>
</tr>
<tr>
<td class="maintext">Mouse (45 Buttons)</td>
<td class="maintext">$12</td>
<td>
<input type="text" name="d_Product1-Quantity" size="5" value="0" class="Textarea-Style">
</td>
</tr>
<tr>
<td class="maintext">Keyboard (365 Buttons)</td>
<td class="maintext">$25</td>
<td>
<input type="text" name="d_Product2-Quantity" size="5" value="0" class="Textarea-Style">
</td>
</tr>
<tr>
<td class="maintext">Modem (56K Voice)</td>
<td class="maintext">$50</td>
<td>
<input type="text" name="d_Product3-Quantity" size="5" value="0" class="Textarea-Style">
</td>
</tr>
</table>
</td>
</tr>
</table>
<div align="center">
<p><font size="2"><br>
<input type="submit" name="Submit" value="..:: PREVIEW ::.." class="buttons">
</font></p>
</div>
</form>
<form name="Simple" method="post" action="/cgi-bin/formprocessorpro.pl">
<div align="center">
</div>
</form>
</body>
</html>
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