YA: Payroll Form BASIC

<html>
    <head>
        <title>Payroll Form</title>
        <style type="text/css">
            /*    Simple styles to make it look a little nicer    */
            input {
                margin-right: 15px;
            }
            input[name*=rate], input[name*=hours] {
                width: 50px;
            }
        </style>
    </head>
<body>
    <form method="post" action="payroll_process.php">
        Company Name: <input type="text" name="company_name">
        <br>
        Date: <input type="text" name="date">
        <br>
        <fieldset>
            <h3>Employee #1</h3>
            Name: <input type="text" name="employee1_name">
            Rate/Hour: $<input type="text" name="employee1_rate">
            Hours Worked: <input type="text" name="employee1_hours">
        </fieldset>
        <fieldset>
            <h3>Employee #2</h3>
            Name: <input type="text" name="employee2_name">
            Rate/Hour: $<input type="text" name="employee2_rate">
            Hours Worked: <input type="text" name="employee2_hours">
        </fieldset>
        <fieldset>
            <h3>Employee #3</h3>
            Name: <input type="text" name="employee3_name">
            Rate/Hour: $<input type="text" name="employee3_rate">
            Hours Worked: <input type="text" name="employee3_hours">
        </fieldset>
        <fieldset>
            <h3>Employee #4</h3>
            Name: <input type="text" name="employee4_name">
            Rate/Hour: $<input type="text" name="employee4_rate">
            Hours Worked: <input type="text" name="employee4_hours">
        </fieldset>
        <fieldset>
            <h3>Employee #5</h3>
            Name: <input type="text" name="employee5_name">
            Rate/Hour: $<input type="text" name="employee5_rate">
            Hours Worked: <input type="text" name="employee5_hours">
        </fieldset>
        <input type="submit" value="Submit">
    </form>
</body>
</html>