Form

<form action="http://formtoemail.com/user_forms.php" method="post" class="basic-grey">
<input type="hidden" name="user_id" value="4H2AZ5XXBQZ95YQJ6Q5Q">
<input type="hidden" name="form_id" value="1">

    <h1>Fair Equipment
        <span>Please fill all the text fields <br>to order the needed equipment</span>
    </h1>

    <b><span>Your info</span></b>
    <label>
        <input id="Name" type="text" name="Name" placeholder="Full Name" />
    </label>

    <label>
        <input id="Email" type="email" name="Email" placeholder="Email Address" />
    </label>

    <label>
        <input id="Purpose" type="text" name="Purpose" placeholder="Purpose of Order" />
    </label>

    <br><FORM><b><span>Mark the equipment that you need</span></b><BR>
    <INPUT TYPE="CHECKBOX" NAME="Equipment1" VALUE="1001">Regular fair desk<BR>
    <INPUT TYPE="CHECKBOX" NAME="Equipment2" VALUE="1002">Desk with oven and sink<BR>
    <INPUT TYPE="CHECKBOX" NAME="Equipment3" VALUE="1003">Isola 1<BR>
    <INPUT TYPE="CHECKBOX" NAME="Equipment4" VALUE="2001">Isola 2<BR>
    <INPUT TYPE="CHECKBOX" NAME="Equipment5" VALUE="2002">Tables & Chairs<BR>
    <INPUT TYPE="CHECKBOX" NAME="Equipment6" VALUE="2003">Bicycle<BR>

    <br><label>
        <input id="Pallets" type="text" name="Pallets" placeholder="Number of pallets" />
    </label>


    <br><br><b>What is the delivery date?</b>
    <TABLE CELLSPACING=5>
    <TR>
    <TD>
    <SELECT NAME="Month">
    <OPTION SELECTED>January<OPTION>February<OPTION>March<OPTION>April
    <OPTION>May<OPTION>June<OPTION>July<OPTION>August<OPTION>September
    <OPTION>October<OPTION>November<OPTION>December
    </SELECT>
    </TD>
    <TD>
    <SELECT NAME="Date">
    <OPTION SELECTED>1<OPTION>2<OPTION>3<OPTION>4<OPTION>5<OPTION>6
    <OPTION>7<OPTION>8<OPTION>9<OPTION>10<OPTION>11<OPTION>12
    <OPTION>13<OPTION>14<OPTION>15<OPTION>16<OPTION>17<OPTION>18
    <OPTION>19<OPTION>20<OPTION>21<OPTION>22<OPTION>23<OPTION>24
    <OPTION>25<OPTION>26<OPTION>27<OPTION>28<OPTION>29<OPTION>30
    <OPTION>31
    </SELECT>
    </TD>
    <TD>
    <SELECT NAME="Year">
    <OPTION SELECTED>2014<OPTION>2015<OPTION>2016<OPTION>2017<OPTION>2018<OPTION>2019
    <OPTION>2020<OPTION>2021<OPTION>2022<OPTION>2023<OPTION>2024<OPTION>2025
    </SELECT>
    </TD>
    </TR>
    </TABLE></P>

    <b>When does it go back? (pick up date)</b>
    <TABLE CELLSPACING=5>
    <TR>
    <TD>
    <SELECT NAME="PickupMonth">
    <OPTION SELECTED>January<OPTION>February<OPTION>March<OPTION>April
    <OPTION>May<OPTION>June<OPTION>July<OPTION>August<OPTION>September
    <OPTION>October<OPTION>November<OPTION>December
    </SELECT>
    </TD>
    <TD>
    <SELECT NAME="PickupDate">
    <OPTION SELECTED>1<OPTION>2<OPTION>3<OPTION>4<OPTION>5<OPTION>6
    <OPTION>7<OPTION>8<OPTION>9<OPTION>10<OPTION>11<OPTION>12
    <OPTION>13<OPTION>14<OPTION>15<OPTION>16<OPTION>17<OPTION>18
    <OPTION>19<OPTION>20<OPTION>21<OPTION>22<OPTION>23<OPTION>24
    <OPTION>25<OPTION>26<OPTION>27<OPTION>28<OPTION>29<OPTION>30
    <OPTION>31
    </SELECT>
    </TD>
    <TD>
    <SELECT NAME="PickupYear">
    <OPTION SELECTED>2014<OPTION>2015<OPTION>2016<OPTION>2017<OPTION>2018<OPTION>2019
    <OPTION>2020<OPTION>2021<OPTION>2022<OPTION>2023<OPTION>2024<OPTION>2025
    </SELECT>
    </TD>
    </TR>
    </TABLE></P>

    <b><span>Delivery Address (where you need it)</span></b><br><br>
    <label>
        <input id="Street" type="text" name="Address" placeholder="Street Address 1" />
        <input id="Street2" type="text" name="Address 2" placeholder="Street Address 2" />
        <input id="Stand" type="text" name="Stand" placeholder="Stand number" />
        <input id="City" type="text" name="City" placeholder="Zip Code and City" />
        <input id="Country" type="text" name="Country" placeholder="Country" />
    </label>

    <br><b><span>Final Address (after being picked up)</span></b><br><br>
    <label>
        <input id="Street" type="text" name="FinalAddress" placeholder="Street Address 1" />
        <input id="Street2" type="text" name="FinalAddress 2" placeholder="Street Address 2" />
        <input id="City" type="text" name="FinalCity" placeholder="Zip Code and City" />
        <input id="Country" type="text" name="FinalCountry" placeholder="Country" />
    </label>


    <br><b><span>Additional Comments</span></b>
    <label>
        <textarea id="message" name="Message" placeholder="Write additional comments here"></textarea>
    </label>


    <label>
        <span>&nbsp;</span>
        <input type="submit" class="button" value="Send" />
    </label>
</form>