Untitled

<!doctype html>

<!-- ***************************************************************************************
    Author     : Jorge Hasbun
    Course     : WEB-Online
    URL        : ocelot.aul.fiu.edu/~jhasb006
    Professor  : Michael Robinson
    Program #  : 2

    Due Date   : 10/2/19
    Certification:
    I hereby certify that this work is my own and none of it is the work of any other person.

    ..........{ Jorge Hasbun }..........

  **************************************************************************************** -->
<html>


<head>

	<title> Hasbun, J - program2.php </title>

</head>

	<?php include('header.php'); ?>
	<br>
	<?php include('mainMenu.php'); ?>

<br>

<form method="POST" action="controller2.php">
<table width="70%" align="center" border="0" cellpadding="10px" cellspacing="10px" font: 15px Calibri >
<tr>
    <tr>

	    <td align="left"> Telephone Number </td>
		<td>
		    <input type="text" name="Telephone" style="width: 100%;">
		</td>

    </tr>

	<tr>
	<td align="left"> Email Address</td>
		<td width="125px">
		    <input type="text" name="Email" style="width: 100%;">
		</td>
	</tr>

	<tr>
		<td width="125px" align="left"> Last, First Name </td>
		<td width="125px">
		    <input type="text" name="lastFirstName" style="width: 600%;">
		</td>
	</tr>

	<tr>
	    <td width="125px" align="left"> Full Address </td>
		<td width="125px">
		    <input type="text" name="fullAddress" style="width: 600%;">
		</td>
	</tr>


	</tr>
	<tr>
	    <td align="right"> City</td>

		<td>
		    <input  name="City"  style="width: 100%;"></input>
		</td>


		<td align="right"> Major </td>
		<td>
		    <input type="radio" name="radName">
			&nbsp; IT
		</td>


		<td>
		    <input type="radio" name="radName">
			&nbsp; CS
		</td>


		<td>
		    <input type="radio" name="radName">
			&nbsp; Robotics
		</td>

		<td>
		    <input type="radio" name="radName">
			&nbsp; Law
		</td>

		<td>
		    <input type="radio" name="radName">
			&nbsp; Cyber
		</td>

	</tr>

	<tr>

	<td align="right"> State </td>

		<td>
		    <input  name="State"  style="width: 100%;"></input>
		</td>

	<td align="right"> Coffee </td>

		<td>
		    <input type="checkbox" name="Light">
			&nbsp; Light
		</td>

		<td>
		    <input type="checkbox" name="Cuban">
			&nbsp; Cuban
		</td>

		<td>
		    <input type="checkbox" name="Sweet">
			&nbsp; Sweet
		</td>

		<td>
		    <input type="checkbox" name="Dark">
			&nbsp; Dark
		</td>

		<td>
		    <input type="checkbox" name="Decaf">
			&nbsp; Decaf
		</td>


	</tr>

	<tr>

	 <td align="right"> Country </td>

		<td>
		    <input  name="Country"  style= "width: 100%;"></input>
		</td>

	    <td align="right"> Dropdown </td>

	    <td colspan="2" align="center">
	        <select name="dropdown" style ="width: 100%";>
			<option value="Choice 1"> Choice 1 </option>
			<option value="Choice 2"> Choice 2 </option>
			<option value="Choice 3"> Choice 3 </option>

			</select>
        </td>


	</tr>
	<tr>
	<td align="right"> Zip</td>

		<td>
		    <input  name="zipCode"  style="width: 100%;"></input>
		</td>

	<td align="right"> Comments</td>

		<td>
		    <textarea  name="Comments"  style="height: 90px; width: 100%;"></textarea>
		</td>
	</tr>

</table>


<p align="center">$message</p>


<div style="text-align: center">
    <input type="submit" value="Save" name="save">
	<input type="submit" value="Find" name="find">
	<input type="submit" value="Modify" name="modify">
	<input type="submit" value="Delete" name="delete">
	<input type="reset" value ="Clear Screen">
</div>
</form>
<br>

	<?php include('mainMenu.php'); ?>


</body>
</html>