input list

<html>

<head>
  <title>Input total list item</title>
  <script type="text/javascript">

  </script>
</head>

<body>

<?php

    $bulan = date("F");
    $tanggal = date("d-Y");

                echo "<form name='formreqlist' action='Form/prosesFormPembelian.php' method='POST'>";
                 echo "<table align='center' width='1024'>";
                    echo "<tr bgcolor='iceblue'>";
                     echo "<td align='center' colspan='2' width='450' ><font face='calibri' size='6' color='white' >SKY NET POS SYSTEM
                           </br>Request Form Purchasing </td>";
                    echo "</tr>";
                    echo "<tr bgcolor='iceblue'>";
                     echo "<td align='center'><font face='calibri' size='4' color='white' >Input purchase total item</td>";
                     echo "<td align='center'><Input type='text' name='listItem'></td>";
                    echo "</tr>";
                    echo "<tr bgcolor='iceblue'>";
                     echo "<td align='center' colspan='2'><font face='calibri' size='4' color='white' >
                           <input type='submit' value='Simpan' onclick='return cek_data()'></td>";
                    echo "</tr>";
                    echo "<tr bgcolor='iceblue'>";
                     echo "<td align='center' colspan='2'><font face='calibri' size='4' color='white' >$bulan </br> $tanggal </td>";
                    echo "</tr>";
                 echo "</table>";
                echo "</form>";

  ?>

</body>
</html>