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<!-- Free Form Style #4 -->

Order Form

Email address:
Your Name:
Shipping and
billing address:
State: Zip:
Item Qty. Unit Price Qty. times Price
Sales Tax
Order Total

Payment Method

Card Type:
Card No:
Expiration Date (mm/dd):
Name Appearing on Card:

Copy and paste the html code below in the black area. If you are using the Page Wizard log into the members main menu and go to the web site manager and paste the html to the introduction or conclusion input area boxes. If your doing your own html, you know what to do. Be sure to change the areas in red or you will not get all your inquiries, and create your own page that says thank you with your own information on it.

<form action="http://cgi.freeyellow.com/cgi-shl/formmail.pl"

<input type="hidden" name="content" value=" "><input

type="hidden" name="recipient" value="youre-mail@your-isp.com"><input

type="hidden" name="redirect"


type="hidden" name="subject" value="Form #4">

<h2>Order Form</h2>

<table border=1><tr><td>Email address:</td><td colspan=3><INPUT NAME="email" TYPE="text" SIZE=30></td></tr>
<tr><td>Your Name:</td><td colspan=3><INPUT NAME="realname" TYPE="text" SIZE=30 MAXSIZE=40></td></tr>
<tr><td rowspan=2>Shipping and<br>billing address:</td><td>Street:</td><td colspan=2><INPUT NAME="Street" TYPE="text" SIZE=21 MAXSIZE=40></td></tr>
<tr><td>City:</td><td colspan=2><INPUT NAME="City" TYPE="text" SIZE=21 MAXSIZE=40></td></tr>
<tr><td>State:</td><td><INPUT NAME="State" TYPE="text" SIZE=6 MAXSIZE40></td><td>Zip:</td><td><INPUT NAME="zip" TYPE="text" SIZE=12 MAXSIZE=15></td></tr>
<tr><th>Item</th><th>Qty.</th><th>Unit Price</th><th>Qty. times Price</th></tr>
<tr><td><INPUT NAME="item1" TYPE="text" SIZE=10 ></td><td><INPUT NAME="qty1" TYPE="text" SIZE=6 ></td><td><INPUT NAME="up1" TYPE="text" SIZE=6 ></td><td><INPUT NAME="ext1" TYPE="text" SIZE=12 ></td></tr>
<tr><td><INPUT NAME="item2" TYPE="text" SIZE=10 ></td><td><INPUT NAME="qty2" TYPE="text" SIZE=6 ></td><td><INPUT NAME="up2" TYPE="text" SIZE=6 ></td><td><INPUT NAME="ext2" TYPE="text" SIZE=12 ></td></tr>
<tr><td><INPUT NAME="item3" TYPE="text" SIZE=10 ></td><td><INPUT NAME="qty3" TYPE="text" SIZE=6 ></td><td><INPUT NAME="up3" TYPE="text" SIZE=6 ></td><td><INPUT NAME="ext3" TYPE="text" SIZE=12 ></td></tr>
<tr><td><INPUT NAME="item4" TYPE="text" SIZE=10 ></td><td><INPUT NAME="qty4" TYPE="text" SIZE=6 ></td><td><INPUT NAME="up4" TYPE="text" SIZE=6 ></td><td><INPUT NAME="ext4" TYPE="text" SIZE=12 ></td></tr>
<tr><td><INPUT NAME="item5" TYPE="text" SIZE=10 ></td><td><INPUT NAME="qty5" TYPE="text" SIZE=6 ></td><td><INPUT NAME="up5" TYPE="text" SIZE=6 ></td><td><INPUT NAME="ext5" TYPE="text" SIZE=12 ></td></tr>
<tr><td colspan=3>Subtotal</td><td><INPUT NAME="SH" TYPE=text SIZE=12 ></td></tr>
<tr><td colspan=3>Shipping/handling</td><td><INPUT NAME="SH" TYPE=text SIZE=12 ></td></tr>
<tr><td colspan=3>Sales Tax</td><td><INPUT NAME="Tax" TYPE="text" SIZE=12 ></td></tr>
<tr><td colspan=3>Order Total</td><td><INPUT NAME="Total" TYPE="text" SIZE=12 ></td></tr>
<b>Payment Method</b><br>
<tr><td>Card Type:</td><td><SELECT NAME="card_type" >
<OPTION VALUE="">Choose Card Type
<OPTION VALUE="MC">MasterCharge
<OPTION VALUE="D">Discover
<OPTION VALUE="AX">American Express
<tr><td>Card No:</td><td><INPUT NAME="card_no" TYPE="text" SIZE=19 MAXSIZE=19></td></tr>
<tr><td>Expiration Date (mm/dd):</td><td><INPUT NAME="card_exp_date" TYPE="text" SIZE=5 ></td></tr>
<tr><td>Name Appearing on Card:</td><td><INPUT NAME="cc_name" TYPE="text" SIZE=19></td></tr>
<INPUT TYPE="submit" VALUE="Submit Order!"><br>

The first red code is for you to insert your
e-mail address@freeyellow.com...

The second red area is for you to change it so they go to your thankyou page, so simply create a page and rename it thankyou.html As soon as someone fills out the form they will be taken to Your thank you page, so maybe say something like "Thanks for giving us your input. Click here to go back to the main page. You get the idea.

The third red area is for you to change the subject of the message. This one will default and say Form #4 As an example you may want to put From My Free Yellow page, and everytime someone sends through this form, it will say in the subject field From My Free Yellow page. It's up to you.

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