<html><head>
<title>yamform test: Widget Request Form</title>
</head>
<body>
<h1>yamform test: Widget Request Form</h1>
Widget Services supplies widgets only to registered students, faculty
and staff of Foobar University.
To pick up your widget go to Room 101 between the hours of 1-2 pm
Monday through Wednesday.

<form method=post action="http://riceinfo.rice.edu/cgi-bin/yamform?username@girltech.cs.rice.edu">

<pre>
E-mail address: <input type=text name=from> <em>(Complete address, e.g. "jdoe@foo.edu"!)</em>
Name: <input type=text name=name>
Department: <input type=text name=department>
Phone: <input type=text name=phone>
</pre>
<p>
<pre>
Favorite web page title: <input type=text name=favetitle>
Favorite web page URL: <input type=text name=faveurl>
</pre>
<p>
Widget shape:
<select name="shape">
<option> Round
<option selected> Triangular
<option> Square </select>
<p>
Widget color:
<input type=radio name=color value="Blue" checked> Blue
<input type=radio name=color value="Yellow"> Yellow
<input type=radio name=color value="Red"> Red
<p>
Widget options:
<input type=checkbox name=pinopt value="yes"> Pinstriping
<input type=checkbox name=turbopt value="yes"> Turbo
<input type=checkbox name=luxopt value="yes"> DeLuxe

<p>
What additional features would you like to see in a widget?
<textarea name=comments rows=3 cols=72></textarea>

<br>

<p>Select <input type=submit value="Submit"> to submit your request.<br>
Select <input type=reset> to erase everything in the form. </p>

<input name=subject type=hidden value="yamform test: Widget Request Form from $from">

<input name=outform1 type=hidden value="
WIDGET REQUEST FORM

Personal info:
E-mail address: $from
Name: $name
Department: $department
Phone: $phone

Favorite web page: &lt;a href=&quot;$faveurl&quot;&gt;$favetitle&lt;/a&gt;

Widget info:
Widget shape: $shape
Widget color: $color

Widget options:
Pinstriping: $pinopt
Turbo: $turbopt
DeLuxe: $luxopt

Additional features:
$comments
">
<input name=outform3 type=hidden value="
---------------------------------------------------------------------
FOR OFFICE USE ONLY:
Processed by: _________ Date: _________ Approved [ ] Denied [ ]
---------------------------------------------------------------------
">
<input name=outform4 type=hidden value="
WIDGSUM,&quot;$name&quot;,$shape,$color,$pinopt,$turbopt,$luxopt">
</form>

</body>
</html>