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<h1 style="text-align:center;font-family:arial;color:red;font-size:70px;"><u>Tasmanian ECig</u></h1>
<h2 style="text-align:center;font-family:arial;color:purple;font-size:25px;>"<i>"Selling High Quality Electronic Cigarettes with a variety of Top Range brands since 2011</i>"</h2>

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<p><b>In order to register with AusCigs you must complete the account registration form</b></p>

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<select>
  <option value="Smoker 1-5 years">Smoker of 1-5 years</option>
  <option value="Smoker 5-10 years">Smoker of 5-10 years</option>
  <option value="Smoker 10-15 years">Smoker of 10-15 years</option>
  <option value="Non-Smoker">Non-Smoker</option>
</select>

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<form>
<input type="radio" name="sex" value="male" /> Male<br />
<input type="radio" name="sex" value="female" /> Female
</form>

<form>
<input type="checkbox" name="identification" value="Drivers License" /> I have a Drivers License<br/>
<input type="checkbox" name="identification" value="Bill" /> I have a Bill<br />

<input type="checkbox" name="identification" value=""Birth Certificate" /> I have a Birth Certificate<br/>
</form>

<form>
<input type="radio" name="Age" value="age" />I am 18 years or older
</form>

<form>
First name: <input type="text" name="firstname" /><br />
Last name: <input type="text" name="lastname" /><br />
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Address 1: <input type="text" name="address 1" /><br />
Address 2: <input type="text" name="address 2" /><br />

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Suburb: <input type="text" name="suburb" /><br />
State: <input type="text" name="state" /><br />
Country: <input type="text" name="country" /><br />
</form>

<form>
Username: <input type="Username" type="text" /><br />
Password: <input type="password" name="pwd" />
</form>

<form>
Email: <input type="email address" type="text" /><br />

</form>

<form>
Bank Name: <input type="bankaccountname" type="text" /><br />
Account Name: <input type="accountname" type="text" /><br />
Account Number: <input type="accountnumber" type="text" /><br />
BSB: <input type="bsb" type="text" /><br />

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<br><form name="input" action="this area decides where you send you input/to what page it is sent" method="get">
Email add. Verification: <input type="text" name="verification" />

<input type="submit" value="Submit" />
</form>

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<form>
<input type="checkbox" name="identification" value="Drivers License" /> I have a Drivers License</br>
<input type="checkbox" name="identification" value="Bill" /> I have a Bill<br />
<input type="checkbox" name="identification" value=""Birth Certificate" /> I have a Birth Certificate</br>
</form>


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<h1 style="text-align:center;font-family-arial;font-color:darkblue;font-size:20px;>"><u>Terms and Conditions</u></h1>

<p>By ticking the below boxes you agree that you are of 18 years of age or older and that you have fully read and agree to the Terms and Conditions set out in this section. Paid for product will be forfeited in the event that it is discovered you supplied incorrect or false details when making an order with AusCig. Possible prosecution may follow as a direct result of provided fake documentation(submitted in the Verification section). I agree that if I open or damage in anyway the product I recieve I forfeit my legal position to claim Warranty. AusCig does not take responsibility or any liability for the purchasing of addictive additives and subsequent addictions.
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<form>

<input type="checkbox" name="agreement" value="Age Verified" /> I am 18 years or older</br>
<input type="checkbox" name="Terms and Conditions" value="T&C Verified" /> I have read the Terms and Conditions</br>
<input type="checkbox" name="Agree to Terms" value="Agreed" />I Agree to the Terms and Conditions</br>
</form>

<form>
<input type="submit" value="Submit" />
</form>

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