Location: PHPKode > scripts > Link Request Contact Form > link-request-contact-form/link-request-contact-form.html
<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">
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<head>
<title>Link Request Contact Form - American Financing</title>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">
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<body bgcolor="#8080C0">
<div align="center">
  <table width="424" border="0">
    <tr>
      <td width="466"><form method="post" action="output.php" enctype="multipart/form-data">
          <table width="424" border="0" cellpadding="3" cellspacing="0">
            <tr bgcolor="#FFFFFF"> 
              <td colspan="2"><img src="link-image.jpg" width="424" height="139"></td>
            </tr>
            <tr bgcolor="#FFFFFF"> 
              <td width="224"> <div align="right"><font size="2" face="Arial, Helvetica, sans-serif">Full 
                  Name:</font></div></td>
              <td width="194"> <input name="Full_Name" type="text" id="Full_Name" size="26"></td>
            </tr>
            <tr bgcolor="#FFFFFF"> 
              <td> <div align="right"><font size="2" face="Arial, Helvetica, sans-serif">E-mail 
                  Address:</font></div></td>
              <td> <input name="email" type="text" id="email" size="26"></td>
            </tr>
            <tr bgcolor="#FFFFFF"> 
              <td> <div align="right"><font size="2" face="Arial, Helvetica, sans-serif">Where 
                  is the link back to our site?</font></div></td>
              <td> <input name="Link_Back" type="text" id="Link_Back" size="26"></td>
            </tr>
            <tr bgcolor="#FFFFFF"> 
              <td> <div align="right"><font size="2" face="Arial, Helvetica, sans-serif">Your 
                  Site's Title:</font></div></td>
              <td> <input name="Site_Title" type="text" id="Site_Title" size="26"></td>
            </tr>
            <tr bgcolor="#FFFFFF"> 
              <td> <div align="right"><font size="2" face="Arial, Helvetica, sans-serif">Your 
                  Site's Web Address:</font></div></td>
              <td> <input name="You_Web_Address" type="text" id="You_Web_Address" size="26"></td>
            </tr>
            <tr bgcolor="#FFFFFF"> 
              <td> <div align="right"><font size="2" face="Arial, Helvetica, sans-serif">Please 
                  Briefly Describe Your Site:</font></div></td>
              <td> <textarea name="Site_Description" id="Site_Description"></textarea></td>
            </tr>
            <tr bgcolor="#FFFFFF"> 
              <td colspan="2"> <div align="center"><font size="2" face="Arial, Helvetica, sans-serif"><br>
                  <strong><font color="#FF0000" size="1">Banner Upload</font></strong></font><font color="#FF0000" size="1"><strong><font face="Arial, Helvetica, sans-serif"> 
                  - JPG or GIF Only and under 2 megs</font></strong></font><br>
                  <input name="upload" type="file" size="20">
                  <br>
                  <br>
                </div></td>
            </tr>
            <tr bgcolor="#FFFFFF"> 
              <td colspan="2"> <div align="center">
                  <input type="submit" name="Submit" value="Submit">
                  <br>
                  <br>
                </div></td>
            </tr>
          </table>
        </form></td>
    </tr>
  </table>

  <font size="1" face="Arial, Helvetica, sans-serif">Provided By: <a href="http://www.americanfinancing.net">American 
  Financing</a></font></div>
</body>
</html>
Return current item: Link Request Contact Form