Olive Branch MS Chamber of Commerce (circa Oct 1999)
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<?php // info request input form?><table border=0 cellpadding=4 cellspacing=0><form method="post" action="reply.php3"><tr><th colspan=4>Request For More Information</th></tr><tr><td class=label>Name:</td> <td class=data><input type="text" name="name" size=20></td> <td class=label>Title:</td> <td class=data><input type="text" name="title" size=20></td></tr><tr><td class=label>Address:</td> <td class=data><input type="text" name="address" size=20></td> <td class=label>Company:</td> <td class=data><input type="text" name="company" size=20></td></tr><tr><td class=label>City:</td> <td class=data><input type="text" name="city" size=20></td> <td class=label>Phone:</td> <td class=data><input type="text" name="phone" size=20></td></tr><tr><td class=label>State:</td> <td class=data><input type="text" name="state" size=20></td> <td class=label>Fax:</td> <td class=data><input type="text" name="fax" size=20></td></tr><tr><td class=label>Zip:</td> <td class=data><input type="text" name="zip" size=20></td> <td class=label>Email:</td> <td class=data><input type="text" name="email" size=20></td></tr><tr><td colspan=4 class=dropped> <input type="reset"><input type="submit"></td></tr></table>
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