Order Form

Name: Phone: E-mail address:
Billing and Shipping Addresses:
Products to Order:
Qty: Cost: ($40.00 ea) Fictional Spreadsheet 7.0
Qty: Cost: ($69.95 ea) Fictional Word Processor 6.0
Qty: Cost: ($99.95 ea) Fictional Database 7.0
Qty: Cost: ($4.95 ea) Instruction Booklet for the above
Total Cost:
Method of Payment:
Credit Card or Check Number::

 

  • Source 
    <HTML>
<HEAD><TITLE>Order Form</TITLE></HEAD>
<BODY>
<H1>Order Form</H1>
<FORM NAME="order">
<B>Name:</B> <INPUT TYPE="text" NAME="name1" SIZE=20>
<B>Phone: </B><INPUT TYPE="text" NAME="phone" SIZE=15>
<B>E-mail address:</B><INPUT TYPE="text" NAME="email" SIZE=20><BR>
<B>Billing and Shipping Addresses:</B><BR>
<TEXTAREA NAME="billto" COLS=40 ROWS=4>
Enter your billing address here.
</TEXTAREA>
<TEXTAREA NAME="shipto" COLS=40 ROWS=4>
Enter your shipping address here.
</TEXTAREA>
<B>Products to Order:</B><BR>
Qty: <INPUT TYPE="TEXT" NAME="qty1" VALUE="0" SIZE=4>
Cost: <INPUT TYPE="TEXT" NAME="cost1" SIZE=6>
($40.00 ea) Fictional Spreadsheet 7.0 <BR>
Qty: <INPUT TYPE="TEXT" NAME="qty2" VALUE="0" SIZE=4>
Cost: <INPUT TYPE="TEXT" NAME="cost2" SIZE=6>
($69.95 ea) Fictional Word Processor 6.0<BR>
Qty: <INPUT TYPE="TEXT" NAME="qty3" VALUE="0" SIZE=4>
Cost: <INPUT TYPE="TEXT" NAME="cost3" SIZE=6>
($99.95 ea) Fictional Database 7.0 <BR>
Qty: <INPUT TYPE="TEXT" NAME="qty4" VALUE="0" SIZE=4>
Cost: <INPUT TYPE="TEXT" NAME="cost4" SIZE=6>
($4.95 ea) Instruction Booklet for the above <HR>
<B>Total Cost:</B>
<INPUT TYPE="TEXT" NAME="totalcost" SIZE=8><HR>
<B>Method of Payment</B>:
<SELECT NAME="payby">
<OPTION VALUE="check" SELECTED>Check or Money Order
<OPTION VALUE="cash">Cash or Cashier's Check
<OPTION VALUE="credit">Credit Card (specify number)
</SELECT><BR>
<B>Credit Card or Check Number:</B>:
<INPUT TYPE="TEXT" NAME="creditno" SIZE="20"><BR>
<INPUT TYPE="SUBMIT" NAME="submit" VALUE="Send Your Order">
<INPUT TYPE="RESET" VALUE="Start Over">
</FORM>
</BODY>
</HTML>