Olive Branch MS Chamber of Commerce (circa Oct 1999)
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<?php // info request input form
?>
<table border=0 cellpadding=2 cellspacing=0><form method="post" action="reply.php3"><tr> <td><input type="checkbox" name="general" value="send">General Info.</td> <td><input type="checkbox" name="business" value="send">Business Info.</td> <td><input type="checkbox" name="realestate" value="send">Real Estate</td> <td><input type="checkbox" name="schools" value="send">Schools</td></tr><tr> <td><input type="checkbox" name="history" value="send">Historical Info.</td> <td><input type="checkbox" name="rental" value="send">Rental Property</td> <td><input type="checkbox" name="tourism" value="send">Tourist Info.</td> <td><input type="checkbox" name="cityhall" value="send">City Hall Info.</td></tr><tr> <td><input type="checkbox" name="other" value="send">Other Info.</td> <td><input type="checkbox" name="maps" value="send">Area Maps</td> <td><input type="checkbox" name="ind_parks" value="send">Industrial Parks</td> <td><input type="checkbox" name="membership" value="send">Membership Info.</td></tr><tr><td colspan=4>  </td></tr></table><table><tr><td><table border=0 cellpadding=2 cellspacing=0><tr><td class=label>Name:</td> <td class=data><input type="text" name="name" size=20 maxlength=20></td><tr><td class=label>Address:</td> <td class=data><input type="text" name="address" size=20 maxlength=20></td><tr><td class=label>City:</td> <td class=data><input type="text" name="city" size=20 maxlength=20></td><tr><td class=label>State:</td> <td class=data><input type="text" name="state" size=20 maxlength=20></td><tr><td class=label>Zip:</td> <td class=data><input type="text" name="zip" size=20 maxlength=20></td></table></td><td><table border=0 cellpadding=2 cellspacing=0><tr><td class=label>Title:</td> <td class=data><input type="text" name="title" size=20 maxlength=20></td></tr><tr><td class=label>Company:</td> <td class=data><input type="text" name="company" size=20 maxlength=20></td></tr><tr><td class=label>Phone:</td> <td class=data><input type="text" name="phone" size=20 maxlength=20></td></tr><tr><td class=label>Fax:</td> <td class=data><input type="text" name="fax" size=20 maxlength=20></td></tr><tr><td class=label>Email:</td> <td class=data><input type="text" name="email" size=20 maxlength=40></td></tr></table></td></tr></table><table border=0 cellpadding=2 cellspacing=0><tr><td colspan=4 class=dropped> <input type="reset"><input type="submit"></td></tr></table>
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