<title>Please Complete My Form</title>

<form action="http://www.loudoffice.com/class/submit.asp" method="post" target="_blank" name="input_form">

<table align="center" cellpadding="3" cellspacing="3">

<tr>

<td>Name:</td>

<td><input type="text" name="name" value="[Enter]" size="40" maxlength="35"></td>

</tr>

<tr>

<td>Email:</td>

<td><input type="text" name="email" value="" size="20"></td>

</tr>

<tr>

<td>Password</td>

<td><input type="password" name="password" size="20"></td>

</tr>

<tr>

<td>What Fruits Do<br> You Like</td>

<td>

Apples <input type="checkbox" name="fruit" value="apple"><br>

Bananas<input type="checkbox" name="fruit" value="bananas"><br>

Oranges<input type="checkbox" name="fruit" value="oranges" checked><br>

Grapes<input type="checkbox" name="fruit" value="grapes"><br>

None<input type="checkbox" name="fruit" value="none"><br>

</td>

</tr>

<tr>

<td>Would you like to <br>receive email from us?</td>

<td>Yes <input type="radio" name="receive_email" value="Yes">

No <input type="radio" name="receive_email" value="no" checked></td>

</tr>

<tr>

<td>What is your <br>Favorite Season</td>

<td>

<select size="4" name="favorite_season" multiple>

<option>None</option>

<option value="winter">Winter</option>

<option value="spring">Spring</option>

<option value="fall">Fall</option>

<option value="summer">Summer</option>

</select>

</td>

</tr>

<tr>

<td>Do you have<br>any comments</td>

<td><textarea rows="6" cols="27" name="comments"></textarea>

</tr>

<tr>

<td>&nbsp;</td>

<td><input type="submit" name="cmdSubmit" value="Submit Your Form">&nbsp;<input type="reset" value="Clear Form"></td>

</tr>

<input type="hidden" name="hidden_field" value="No one can see me">