Untitled

<html>
<div id="box_form">
<form id="zFormer" method="POST" action="former.php" name="former">
    <p>
        Your Name:<input type="text" value="Adam Panzer" name="z_name">
    </p>
    <p>
        Your Email Address: <input type="text" value="apanzer@zendesk.com" name="z_requester">
    </p>
    <p>
        Subject: <input type="text" value="Who needs a subject?" name="z_subject">
    </p>
    <p>
        Description: <textarea name="z_description">I have this pain in my knee.</textarea>
    </p>
    <p>
        <input type="submit" value="submit" id="submitter">
    </p>
</form>
</div>
</html>