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<HTML> <HEAD> <META HTTP-EQUIV="Content-Type" CONTENT="text/html; charset=iso-8859-1"> <META NAME="GENERATOR" CONTENT="Mozilla/4.04 [en] (Win95; U) [Netscape]"> <TITLE>FORM1</TITLE> </HEAD> <BODY TEXT="#0000FF" LINK="#000000" BACKGROUND="bk10.gif"> <CENTER> <H1> Thank you for visiting<BR> <B><I><FONT SIZE=-1>(Please fill in the details and then click the "Submit Order Form" button)</FONT></I></B></H1></CENTER> <FORM METHOD="POST" ACTION="http://cgibin.erols.com/emilymyers/cgi-bin/order.pl"> <P><B><FONT SIZE=+2>Please send more information about:</FONT></B> <BR><INPUT TYPE="hidden" NAME="recipient" VALUE="[email protected]"><INPUT TYPE="hidden" NAME="subject" VALUE="order" "<BR">Name of Artwork <BR><INPUT TYPE="TEXT" NAME="TextField" SIZE="80"> <BR>Artist <BR><INPUT TYPE="TEXT" NAME="TextField" SIZE="80"> <BR> <HR><B><FONT SIZE=+2>Shipping and Contact Information</FONT></B> <P><INPUT TYPE="checkbox" NAME="CheckBox" VALUE="CheckBox"><B><FONT COLOR="#000000">Mr <INPUT TYPE="checkbox" NAME="CheckBox" VALUE="CheckBox">Ms <INPUT TYPE="checkbox" NAME="CheckBox" VALUE="CheckBox">Mrs <INPUT TYPE="checkbox" NAME="CheckBox" VALUE="CheckBox">Miss</FONT></B> <BR><B><FONT COLOR="#000000">Name</FONT></B> <BR><INPUT TYPE="TEXT" NAME="TextField" SIZE="80"> <BR><B><FONT COLOR="#000000">Title</FONT></B> <BR><INPUT TYPE="TEXT" NAME="TextField" SIZE="80"> <BR><B><FONT COLOR="#000000">Company</FONT></B> <BR><INPUT TYPE="TEXT" NAME="TextField" SIZE="80"> <BR><B><FONT COLOR="#000000">Street Address</FONT></B> <BR><INPUT TYPE="TEXT" NAME="TextField" SIZE="80"> <BR><B><FONT COLOR="#000000">City</FONT></B> <BR><INPUT TYPE="TEXT" NAME="TextField" SIZE="80"> <BR><B><FONT COLOR="#000000">State/Province</FONT></B> <BR><INPUT TYPE="TEXT" NAME="TextField" SIZE="80"> <BR><B><FONT COLOR="#000000">ZIP Code/Postal Code</FONT></B> <BR><INPUT TYPE="TEXT" NAME="TextField" SIZE="80"> <BR><B><FONT COLOR="#000000">Telephone</FONT></B> <BR><INPUT TYPE="TEXT" NAME="TextField" SIZE="4"><B><FONT COLOR="#000000">- </FONT></B><INPUT TYPE="TEXT" NAME="TextField" SIZE="8"> <BR><B><FONT COLOR="#000000">Fax</FONT></B> <BR><INPUT TYPE="TEXT" NAME="TextField" SIZE="4"><B><FONT COLOR="#000000">- </FONT></B><INPUT TYPE="TEXT" NAME="TextField" SIZE="8"> <BR><B><FONT COLOR="#000000">Email Address</FONT></B> <BR><INPUT TYPE="TEXT" NAME="TextField" SIZE="80"> <BR> <HR> <BR><B></B> <P><INPUT TYPE="SUBMIT" NAME="Button" VALUE="Submit Order Form"><FONT COLOR="#000000">( <B><I>Click here when your information input has been completed</I></B> )</FONT> <BR><INPUT TYPE="RESET" NAME="Button" VALUE="Clear Form"></FORM> </BODY> </HTML>