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<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Strict//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd">
<html>
<head>
<style type="text/css">
form h2, form label {
font-size: 15px;
padding: 3px;
}
</style>
<title>Feedback Form - Widgets and What's-its</title>
</head>
<body>
<h1>Widgets and What's-its</h1>
<form>
<h2>Tell us what's on your mind..</h2>
<div>
<label for='feedback[name]'>Name:</label>
<input type='text' size='25' name='feedback[name]' />
</div>
<div>
<label for='feedback[email]'>Email:</label>
<input type='text' size='25' name='feedback[email]' />
</div>
<div>
<label for='feedback[address]'>Address:</label>
<textarea name='feedback[address]' cols='40' rows='3' wrap='virtual'></textarea>
</div>
<div>
<label for='feedback[message]'>Comments:</label>
<textarea name='feedback[message]' cols='40' rows='6' wrap='virtual'></textarea>
</div>
<div>
<label for='feedback[heard]'>How'd you hear about us?</label>
<select name='feedback[heard]'>
<option value=''>Choose...</option>
<option value='newspaper'>Newspaper</option>
<option value='magazine'>Magazine</option>
<option value='television'>Television</option>
<option value='radio'>Radio</option>
<option value='other'>Other</option>
</select>
</div>
</form>
</body>
</html>
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