<form action="mailto:support@hostgeek.eu?subject=Registration of hostzanula.com" method="post" enctype="text/plain">
<table><tr><td>
firstname: <INPUT NAME="firstname" TYPE="text" VALUE="Your Firstname" SIZE=20><BR>
lastname: <INPUT NAME="lastname" TYPE="text" VALUE="Your Lastname" SIZE=20><BR>
domain: <INPUT NAME="domain" TYPE="text" VALUE="Domain" SIZE=20><BR>
address: <INPUT NAME="address" TYPE="text" VALUE="Address" SIZE=20><BR>
city: <INPUT NAME="city" TYPE="text" VALUE="City" SIZE=20><BR>
state: <INPUT NAME="state" TYPE="text" VALUE="State" SIZE=20><BR>
zipcode: <INPUT NAME="zipcode" TYPE="text" VALUE="Zip Code" SIZE=20><BR>
country: <INPUT NAME="country" TYPE="text" VALUE="Country" SIZE=20><BR>
username: <INPUT NAME="username" TYPE="text" VALUE="Your username" SIZE=20><BR>
password: <INPUT NAME="password" TYPE="text" VALUE="Your password" SIZE=20><BR>

</td></tr>
<tr><td align=center>
<INPUT TYPE="submit" value="Register!" style="color: #ffffff; background-color: #000000">
</td></tr></table>
</FORM>