<form name="form1" method="post" action="../../php/formmail.php">
  <div class="mail_form_div">
    <table class="mail_form_table">
        <tbody>

            <tr>
                <td class="mail_form_td_field_title"><span class="mail_form_large_text">First Name (First, Last):</span></td>
              <td class="mail_form_td"><input type="text" name="first_name" />
                <input type="text" name="last_name" /></td>
            </tr>
			<tr>
                <td class="mail_form_td_field_title"><span class="mail_form_large_text">Address:
              </span></td>
                <td class="mail_form_td"><input name="address" type="text" id="address" size="50" /></td>

            </tr>
			<tr>
                <td class="mail_form_td_field_title"><span class="mail_form_large_text">&nbsp;
              </span></td>
                <td class="mail_form_td"><input name="address2" type="text" id="address2" size="50" /></td>

            </tr>
			<tr>
                <td class="mail_form_td_field_title"><span class="mail_form_large_text">City, State ZIP:
                </span></td>
              <td class="mail_form_td"><input name="city" type="text" id="city" />
                , <select name="state" size="1">
		<option >-not selected-</option>
		<option value="Alabama" >Alabama</option>
		<option value="Alaska" >Alaska</option>
		<option value="Arizona" >Arizona</option>
		<option value="Arkansas" >Arkansas</option>
		<option value="California" >California</option>
		<option value="Colorado" >Colorado</option>
		<option value="Connecticut" >Connecticut</option>
		<option value="Delaware" >Delaware</option>
		<option value="Dist of Columbia" >Dist of Columbia</option>
		<option value="Florida" >Florida</option>
		<option value="Georgia" >Georgia</option>
		<option value="Hawaii" >Hawaii</option>
		<option value="Idaho" >Idaho</option>
		<option value="Illinois" >Illinois</option>
		<option value="Indiana" >Indiana</option>
		<option value="Iowa" >Iowa</option>
		<option value="Kansas" >Kansas</option>
		<option value="Kentucky" >Kentucky</option>
		<option value="Louisiana" >Louisiana</option>
		<option value="Maine" >Maine</option>
		<option value="Maryland" >Maryland</option>
		<option value="Massachusetts" >Massachusetts</option>
		<option value="Michigan" >Michigan</option>
		<option value="Minnesota" >Minnesota</option>
		<option value="Mississippi" >Mississippi</option>
		<option value="Missouri" >Missouri</option>
		<option value="Montana" >Montana</option>
		<option value="Nebraska" >Nebraska</option>
		<option value="Nevada" >Nevada</option>
		<option value="New Hampshire" >New Hampshire</option>
		<option value="New Jersey" >New Jersey</option>
		<option value="New Mexico" >New Mexico</option>
		<option value="New York" >New York</option>
		<option value="North Carolina" >North Carolina</option>
		<option value="North Dakota" >North Dakota</option>
		<option value="Ohio" >Ohio</option>
		<option value="Oklahoma" >Oklahoma</option>
		<option value="Oregon" >Oregon</option>
		<option value="Pennsylvania" >Pennsylvania</option>
		<option value="Rhode Island" >Rhode Island</option>
		<option value="South Carolina" >South Carolina</option>
		<option value="South Dakota" >South Dakota</option>
		<option value="Tennessee" >Tennessee</option>
		<option value="Texas" >Texas</option>
		<option value="Utah" >Utah</option>
		<option value="Vermont" >Vermont</option>
		<option value="Virginia" >Virginia</option>
		<option value="Washington" >Washington</option>
		<option value="West Virginia" >West Virginia</option>
		<option value="Wisconsin" >Wisconsin</option>
		<option value="Wyoming" >Wyoming</option>
	</select> <input name="zip" type="text" id="zip" size="10">

				
				</td>

            </tr>
			<tr>
                <td class="mail_form_td_field_title" colspan="2">&nbsp;</td>
			</tr>
            <tr>
                <td class="mail_form_td_field_title"><span class="mail_form_large_text">Email:</span></td>
                <td class="mail_form_td"><input name="email" type="text" id="email" size="50" /></td>
            </tr>
            <tr>
                <td class="mail_form_td_field_title"><span class="mail_form_large_text">Email Confirm:</span></td>
                <td class="mail_form_td"><input name="email_confirm" type="text" id="email_confirm" size="50" /></td>

            </tr>
            <tr>
                <td class="mail_form_td_field_title" colspan="2">&nbsp;&nbsp;</td>
            </tr>
            <tr>
                <td class="mail_form_td_field_title"><span class="mail_form_large_text">Home Phone:</span></td>
                <td class="mail_form_td"><input type="text" name="home_phone" /><input type="radio" value="home" name="preferred_phone" /><span class="mail_form_small_text"> Preferred Phone</span></td>

            </tr>
            <tr>
                <td class="mail_form_td_field_title"><span class="mail_form_large_text">Work Phone:</span></td>
                <td class="mail_form_td"><input type="text" name="work_phone" /><input type="radio" value="work" name="preferred_phone" /><span class="mail_form_small_text"> Preferred Phone</span></td>
            </tr>
            <tr>
                <td class="mail_form_td_field_title"><span class="mail_form_large_text">Cell Phone:</span></td>

                <td class="mail_form_td"><input type="text" name="cell_phone" /><input type="radio" value="cell" name="preferred_phone" /><span  class="mail_form_small_text"> Preferred Phone</span></td>
            </tr>
            <tr>
                <td class="mail_form_td_field_title"><span class="mail_form_large_text">Best time to call:
                </span></td>
                <td class="mail_form_td"><input type="radio" name="best_time" value="day" /><span class="mail_form_large_text">Day</span> <input type="radio" name="best_time" value="evening" /><span class="mail_form_large_text">Evening</span></td>

            </tr>
            <tr>
                <td class="mail_form_td_field_title" colspan="2">&nbsp;</td>
            </tr>
            <tr>
                <td class="mail_form_td_field_title"><span class="mail_form_large_text">Comments:</span></td>

                <td class="mail_form_td"><textarea name="comments" rows="5" cols="50"></textarea></td>
            </tr>

        </tbody>
    </table>
    <p align="center">
    <input type="submit" name="Submit" value="Submit" />
    <input type="hidden" name="redirect" value="/userfiles/file/contact_return.php" />
    <input type="hidden" name="subject" value="Information Request" />
    <input type="hidden" name="from" value="contactform@example.com" />
    <input type="hidden" name="recipient" value="recipient@example.com" />
    <input type="hidden" name="email_required" value="1" />
    <input type="hidden" name="required_fields" value="first_name,last_name" />
    <input type="hidden" name="html_message_page" value="contact_return_message" />
    <input type="hidden" name="table_name" value="contact_form" />
    </p>
  </div>
</form>
<span style="color: rgb(255, 0, 0);">{*** delete *** <p>You may customize this form any way you like.  You must at the very least set the value of the hidden field &quot;recipient&quot; to the email you would like the contact information to go to. <b>Hot tip:</b> To inhibit robots from harvesting your recipient email address, replace the " <b>@</b> " sign with " <b>+++++</b> " (5 plus signs). You may also change the other hidden fields &quot;subject&quot; and &quot;from&quot; to customize the email being sent, and &quot;email_required&quot; and &quot;required_fields&quot; to determine which fields are required.  </p>
<p>You will also want to create a page named &quot;contact_return&quot; for display after the form is successfully submitted. (You may change the name of the return page by changing the value of the hidden field &quot;redirect&quot; if you want to have different return pages for different contact forms.)  </p>
<p>If you want to send a message back to the inquirer, create a page named &quot;contact_return_message&quot; and embed &quot; [FIRST_NAME] [LAST_NAME] &quot; into your page where you want their first and last names to go, i.e. &quot;Dear Joe,&quot;.  (Note: If you want to show only first name, simply leave out &quot; [LAST_NAME] &quot;.) (You may change the name of the return message page by changing the value of the hidden field &quot;html_message_page&quot; if you want to have different return messages for different contact forms.) </p>
<p>The contact form will also store data into a table called &quot;contact_form&quot;. If you want to change the name of this table (i.e. you have more than one contact forms for different purposes), change the value for the hidden field &quot;table_name&quot;. (The form mailer creates the table automatically upon first use based upon the fields you have in the form.)</p>  *** delete ***}             </span>
