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<!-- Free Form Style #2 -->

E-Mail

Billing Address

Day Phone ext homework
Eve Phone ext homework

First Name Middle Initial Last Name
Address


City

State/Providence

Zip or Postal Code



Shipping Address

Use Billing Address for Shipping Address

First Name Middle Initial Last Name
Address

City State/Province
Zip C R
Day Phone Ext Home Work

Ship Method

UPS
Parcel Post
Express (3 Day) Day phone in shipping address is required
Express (2 Day) Day phone in shipping address is required

Credit Card

AMEX
Optima
Visa
MasterCard
Discover
FCNB


Not Secure Credit Card #
Expiration Date (MM/DD/YY or MM/YY)

 


Comments


Order confirmation should be
Phoned
Reach me at
Faxed
Fax me at
Emailed (address proved at the top)

 

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.

<!--Begin Free Yellow Form #2-->

<blockquote>

<blockquote>

<blockquote>

<p>&nbsp;</p>

</blockquote>

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

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

type="hidden" name="recipient"

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

name="redirect"

value="http://www.freeyellow.com/members/yourusername/thankyou.html""><input

type="hidden" name="subject" value="Form #2"><blockquote>

<blockquote>

<blockquote>

<p align="left">E-Mail<input type="text"

size="28" name="email"></p>

</blockquote>

</blockquote>

<p align="left"><font size="4" face="Arial"><strong>Billing

Address</strong></font></p>

</blockquote>

<p align="left"><input type="text" size="20"

name="T2">Day Phone <input type="text" size="7"

name="T3">ext <input type="radio" checked name="R1"

value="V1">home<input type="radio" name="R1"

value="V2">work<br>

<input type="text" size="20" name="T4">Eve Phone <input

type="text" size="7" name="T5">ext <input

type="radio" name="R1" value="V3">home<input

type="radio" name="R1" value="V4">work<br>

</p>

<p align="left">First Name<input type="text"

size="20" name="T6"> Middle Inital<input type="text"

size="3" name="T7"> Last Name<input type="text"

size="20" name="T8"><br>

Address <br>

<input type="text" size="37" name="T9"> <br>

<input type="text" size="37" name="T10"><br>

City<br>

<input type="text" size="20" name="T11"><br>

State/Providence<br>

<input type="text" size="20" name="T12"><br>

Zip or Postal Code<br>

<input type="text" size="20" name="T13"><br>

</p>

<hr noshade>

<p align="left"><br>

<font size="4" face="Arial"><strong>Shipping Address<br>

</strong></font></p>

<p align="left">Use Billing Address for Shipping

Address <input type="checkbox" checked

name="bill2ship" value="true"></p>

<p align="left">First Name <input type="text"

size="20" maxlength="25" name="ship_first"> Middle

Initial <input type="text" size="2" maxlength="1"

name="ship_middle"> Last Name <input type="text"

size="20" maxlength="25" name="ship_last"><br>

<font size="2">Address<br>

</font><input type="text" size="50" maxlength="50"

name="ship_address1"><br>

<input type="text" size="50" maxlength="50"

name="ship_address2"> City <input type="text"

size="12" maxlength="20" name="ship_city">

State/Province <input type="text" size="3"

maxlength="2" name="ship_state"><br>

Zip <input type="text" size="10" maxlength="10"

name="ship_zip"> <input type="radio" checked

name="ship_zip_type" value="C"> C <input type="radio"

name="ship_zip_type" value="R"> R<br>

Day Phone <input type="text" size="12" maxlength="18"

name="ship_dayphone"> Ext <input type="text" size="4"

maxlength="6" name="ship_dayphone_ext"> <input

type="radio" name="ship_dayphone_loc" value="home">

Home <input type="radio" checked

name="ship_dayphone_loc" value="work"> Work<br>

</p>

<h3 align="left">Ship Method</h3>

<p align="left"><input type="radio" checked

name="ship_method" value="ups"> UPS<br>

<input type="radio" name="ship_method"

value="parcelpost"> Parcel Post<br>

<input type="radio" name="ship_method"

value="express3"> Express (3 Day) <em>Day phone in

shipping address is required</em><br>

<input type="radio" name="ship_method"

value="express2"> Express (2 Day) <em>Day phone in

shipping address is required</em><br>

</p>

<h3 align="left"><a name="creditcard">Credit Card</a></h3>

<p align="left"><a name="creditcard"><input

type="radio" checked name="credit_card" value="amex">

AMEX<br>

<input type="radio" name="credit_card" value="optima">Optima<br>

<input type="radio" name="credit_card" value="visa">

Visa<br>

<input type="radio" name="credit_card" value="mc">

Mastercard<br>

<input type="radio" name="credit_card"

value="discover"> Discover<br>

<input type="radio" name="credit_card" value="fcnb">

FCNB<br>

<br>

<br>

<input type="radio" name="credit_method"

value="manual"> <b>Not Secure</b> Credit Card #<input

type="text" size="30" maxlength="30"

name="credit_number"><br>

Expiration Date <input type="text" size="8"

maxlength="8" name="credit_expiration"> (MM/DD/YY or

MM/YY)</a></p>

<p align="left">&nbsp;</p>

<hr>

<h2 align="left"><a name="creditcard"><font

face="Arial"><strong>Comment</strong></font></a><font

face="Arial"><strong>s</strong></font></h2>

<p align="left"><a name="creditcard"><textarea

name="comment" rows="8" cols="75" maxrows="2"

wrap="1"></textarea></a></p>

<hr noshade>

<p align="left"><a name="creditcard">Order

confirmation should be<br>

<input type="radio" name="order_conf" value="phone">

Phoned<br>

Reach me at <input type="text" size="25"

maxlength="60" name="order_conf_info"><br>

<input type="radio" name="order_conf" value="fax">

Faxed <br>

Fax me at <input type="text" size="25" maxlength="60"

name="order_conf_info"><br>

<input type="radio" checked name="order_conf"

value="email"> Emailed <em>(address proved at the

top)</em><br>

</a></p>

<p align="left"><a name="creditcard"><input

type="submit" name="process" value="Submit Order"> <input

type="reset" value="Clear"> </a></p>

</form>

<!--End Free Yellow Form #2-->

 

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 thank you page, so simply create a page and name it thank you.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. 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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