<form name="form" action="(EmptyReference!)" method="post">
			<table border="0" cellpadding="4" cellspacing="2">
				<tr>
					<td width="64">Item</td>
					<td colspan="2"><input type="text" name="name" size="36"></td>
				</tr>
				<tr>
					<td width="64"></td>
					<td colspan="2"></td>
				</tr>
				<tr>
					<td width="64"></td>
					<td width="109">
						<div align="left">
							<input type="submit" name="submit" value="Submit"></div>
					</td>
					<td align="right">
						<div align="left">
							<input type="reset" value="Clear"></div>
					</td>
				</tr>
			</table>
		</form>