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<br /> <table width="100%"> <tr> <td valign="top"> <form action="index.asp" method="post" name="Request" id="Request"> <table width="100%" > <tr> <td ><span class="style4">First Name</span></td> <td ><span class="style4"> <input name="FirstName" type="text" class="button" value="" size="12" maxlength="50" /> Last Name <input name="LastName" type="text" class="button" value="" size="12" maxlength="50" /> </span></td> </tr> <tr> <td ><span class="style4">Email</span></td> <td ><input name="Email" type="text" class="button" value="" size="25" maxlength="50" /></td> </tr> <tr> <td ><span class="style4">Address</span></td> <td ><input name="Address" type="text" class="button" value="" size="30" maxlength="50" /></td> </tr> <tr> <td ><span class="style4">City</span></td> <td ><span class="style4"> <input name="City" type="text" class="button" value="" size="15" maxlength="50" /> State <input name="State" type="text" class="button" value="" size="2" maxlength="50" /> Zip <input name="Zip" type="text" class="button" value="" size="10" maxlength="50" /> </span></td> </tr> <tr> <td ><span class="style4">Phone</span></td> <td ><span class="style4"> <input name="Home" type="text" class="button" value="" size="15" maxlength="50" /> </span></td> </tr> <tr> <td ><span class="style4">Comments</span></td> <td ><textarea name="Comments" cols="45" rows="10" class="button style4"></textarea></td> </tr> <tr> <td colspan="2" align="right"><!-- *** Buttons *** --> <input type="hidden" value="insert" name="FormAction" /> <input name="submit2" type="submit" class="button" onclick="document.Request.FormAction.value = 'insert';" value="Submit" /> <input name="submit2" type="submit" class="button" onclick="document.Request.FormAction.value = 'cancel';" value="Cancel"/> <input type="hidden" name="FormName" value="Request"/> <input type="hidden" name="PK_ID" value=""/> <input type="hidden" name="ID" value="Rev."/> </td> </tr> </table> </form> </td> </tr> </table>
