<!--The following form uses a RPG CGI Program to --> <!--process the input data. --> <form action="/BonusCGI/imvr501.PGM" METHOD="POST"> <p>Please provide the following information:</p> <b> <pre> Name <input type=text size=25 maxlength=25 name="FNAME"> E-mail <input type=text size=25 maxlength=30 name="EMAIL"> Street address <input type=text size=25 maxlength=25 name="ADDRESS1"> Address (cont.) <input type=text size=25 maxlength=25 name="ADDRESS2"> City <input type=text size=25 maxlength=25 name="CITY"> State/Province <input type=text size=3 maxlength=3 name="STATE"> Zip/Postal code <input type=text size=12 maxlength=12 name="ZIPCODE"> Country <input type=text size=25 maxlength=25 name="COUNTRY"> Phone Number <input type=text size=14 maxlength=14 name="PHONE"> Comments <textarea name="COMMENT" rows=5 cols=42></textarea> </pre></b> <p><input type=submit value="Submit Form"> <input type=reset value="Clear Form"> </p> </form>
CGI020