<html xmlns="http://www.w3.org/1999/xhtml"><head><title></title><style type="text/css">table { border-collapse: collapse; color: black; border: 1px solid black;}th { width: 200px; text-align: right; padding-right: 12px; padding-top: .75em; padding-bottom: .75em; vertical-align: top; border-top: 1px solid black; font-family: Verdana; font-size: .7em;}td { vertical-align: middle; background-color: pink; border-bottom: 1px solid white; color: white; border-left: 4px solid grey; padding: 4px; font-family: Verdana; font-size: .7em;}.required { color: red;}.header th { text-align: left; text-transform: uppercase; font-size: .9em; padding-left: 220px; border-bottom: 2px solid grey; border-top: 2px solid black;}#buttonSubmit { margin-left: 220px; margin-top: 4px;} </style></head><body><form action="" method="post"> <table cellspacing="0"> <tr class="header"> <th colspan="2">Account Information</th> </tr> <tr class="required"> <th scope="row">Login Name*</th> <td> <input name="uname" type="text" size="12" maxlength="12" /> </td> </tr> <tr class="required"> <th scope="row">Password*</th> <td><input name="pword" type="text" size="12" maxlength="12" /></td> </tr> <tr class="required"> <th scope="row">Confirm Password* </th> <td><input name="pword2" type="text" size="12" maxlength="12" /></td> </tr> <tr class="required"> <th scope="row">Email Address*</th> <td><input name="email" type="text" /></td> </tr> <tr class="header"> <th colspan="2">Contact Information</th> </tr> <tr class="required"> <th scope="row">First Name* </th> <td><input name="fname" type="text" size="11" /></td> </tr> <tr class="required"> <th scope="row">Last Name* </th> <td><input name="lname" type="text" size="11" /></td> </tr> <tr class="required"> <th scope="row">Address 1*</th> <td><input name="address1" type="text" size="11" /></td> </tr> <tr> <th scope="row">Address 2 </th> <td><input type="text" name="address2" /></td> </tr> <tr class="required"> <th scope="row">City* </th> <td><input type="text" name="city" /></td> </tr> <tr class="required"> <th scope="row">State or Province*</th> <td><select name="state"> <option selected="selected" disabled="disabled">Select...</option> <option value="alabama">Alabama</option> </select></td> </tr> <tr class="required"> <th scope="row">Zip*</th> <td><input name="zipcode" type="text" id="zipcode" size="5" maxlength="5" /></td> </tr> <tr class="required"> <th scope="row">Country*</th> <td><input type="text" name="country" id="country" /></td> </tr> <tr class="required"> <th scope="row">Gender*</th> <td> <input type="radio" name="sex" value="female" /> Female <input type="radio" name="sex" value="male" /> Male </td> </tr> <tr class="header"> <th colspan="2">Misc. </th> </tr> <tr> <th scope="row"> Income </th> <td> <select name="income" size="1" > <option selected="selected" disabled="disabled">Select...</option> <option value="notsay">no</option> </select> </td> </tr> <tr> <th scope="row">Interests</th> <td><input name="interests" type="checkbox" value="shopping-fashion" /> Shopping/fashion <input name="interests" type="checkbox" value="sports" /> Sports <input name="interests" type="checkbox" value="travel" /> Travel</td> </tr> <tr> <th scope="row">Eye Color</th> <td><input name="eye" type="checkbox" value="red" /> Red <input name="eye" type="checkbox" value="green" /> Green <input name="eye" type="checkbox" value="brown" /> Brown <input name="eye" type="checkbox" value="blue" /> Blue Gold</td> </tr> </table> <input type="submit" name="Submit" value="Submit" id="buttonSubmit" /> <input type="reset" name="Submit2" value="Reset" id="buttonReset" /></form></body></html>
