<?xml version="1.0" encoding="UTF-8"?>

<form url="simple-survey-form.php"
 window="_self"
 method="POST"
 fontname="MS Sans Serif"
 width="681"
 height="521"
 bkcolor="0xFFFFFF"
 transparent="f"
 fontcolor="0x000000"
 outlinecolor="0xC0C0C0"
 themecolor="0xFFFF99"
 fontcolor2="#000000"
 bkcolor2="#FFFFFF"
 includeresults="false"
 emailuser="false"
 verifymessage="The E-Mail address you entered does not match !"
 reqmessage="One or More Fields are Required"
 invalidemailmsg="is an invalid address, please correct it."
 transition="0"
 autoresponseincluderesults="f"
 autoresponseaddtotop="f"
 usephp="true"
 disableclicktoactiveprompt="true"
 extensions="*.txt;*.gif;*.jpg;*.jpeg;*.zip;*.doc;*.png;*.pdf;*.rtf"
>

<hidden
 name="subject"
 value=""
></hidden>

<image
 image="single-line.jpg"
 x="161"
 y="10"
></image>

<image
 image="single-line.jpg"
 x="294"
 y="10"
></image>

<textinput
 name="Name"
 x="256"
 y="60"
 w="175"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
 editable="true"
>
</textinput>

<textinput
 name="Email"
 x="256"
 y="90"
 w="175"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 required="true"
 emailbox="true"
 editable="true"
  restrict="email"
>
</textinput>

<submitbutton
 name="Submit Button"
 x="280"
 y="460"
 w="90"
 h="29"
 label="Send it off!"
 fontname="Arial"
 fontcolor="0x000000"
 image="submitscircularroundmall.png"
  fontsize="12"
></submitbutton>

<textinput
 name="URL"
 x="256"
 y="120"
 w="175"
 h="22"
 initvalue=""
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 editable="true"
>
</textinput>

<label
 name="My Text 1"
 x="219"
 y="65"
 w="33"
 h="16"
 text="Name"
 fontbold="bold"
  fontname="Trebuchet MS"
  fontcolor="0x000000"
  fontsize="11"
></label>

<label
 name="My Text 2"
 x="220"
 y="94"
 w="31"
 h="16"
 text="Email"
 fontbold="bold"
  fontname="Trebuchet MS"
  fontcolor="0x000000"
  fontsize="11"
></label>

<label
 name="My Text 5"
 x="208"
 y="20"
 w="248"
 h="22"
 text="Pie in the Jar Online Order"
 fontbold="bold"
  fontname="Arial"
  fontcolor="0x000000"
  fontsize="19"
></label>

<label
 name="My Text 6"
 x="214"
 y="122"
 w="38"
 h="16"
 text="Phone"
 fontbold="bold"
  fontname="Trebuchet MS"
  fontcolor="0x000000"
  fontsize="11"
></label>

<label
 name="My Text 4"
 x="156"
 y="231"
 w="96"
 h="16"
 text="Credit Card Type"
 fontbold="bold"
  fontname="Trebuchet MS"
  fontcolor="0x000000"
  fontsize="11"
></label>

<label
 name="My Text 8"
 x="124"
 y="436"
 w="425"
 h="16"
 text="Thanks for your order. A conformation email with total cost will be sent soon."
 fontbold="bold"
  fontname="Trebuchet MS"
  fontcolor="0x000000"
  fontsize="11"
></label>

<label
 name="My Text 3"
 x="155"
 y="153"
 w="97"
 h="16"
 text="Shipping Address"
 fontbold="bold"
  fontname="Trebuchet MS"
  fontcolor="0x000000"
  fontsize="11"
></label>

<radiobutton
 name="My Radio Button 1"
 x="260"
 y="230"
 w="40"
 h="19"
 label="Visa"
 labelPos="right"
 groupname="Group 1"
 value="radiobutton1"
  fontsize="12"
  fontname="Arial"
  fontcolor="0x000000"
></radiobutton>

<radiobutton
 name="My Radio Button 2"
 x="307"
 y="230"
 w="83"
 h="19"
 label="Master Card"
 labelPos="right"
 groupname="Group 1"
 value="radiobutton1"
  fontsize="12"
  fontname="Arial"
  fontcolor="0x000000"
></radiobutton>

<radiobutton
 name="My Radio Button 3"
 x="396"
 y="230"
 w="116"
 h="19"
 label="American Express"
 labelPos="right"
 groupname="Group 1"
 value="radiobutton1"
  fontsize="12"
  fontname="Arial"
  fontcolor="0x000000"
></radiobutton>

<textinput
 name="My Input Box 2"
 x="256"
 y="261"
 w="175"
 h="22"
 initvalue=""
 maxchars="25"
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 editable="true"
>
</textinput>

<label
 name="My Text 7"
 x="162"
 y="264"
 w="88"
 h="16"
 text="Credit Card No#"
 fontbold="bold"
  fontname="Trebuchet MS"
  fontcolor="0x000000"
  fontsize="11"
></label>

<label
 name="My Text 9"
 x="196"
 y="298"
 w="53"
 h="16"
 text="Auth No#"
 fontbold="bold"
  fontname="Trebuchet MS"
  fontcolor="0x000000"
  fontsize="11"
></label>

<textinput
 name="My Input Box 3"
 x="256"
 y="293"
 w="175"
 h="22"
 initvalue=""
 maxchars="25"
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 editable="true"
>
</textinput>

<textarea
 name="My Text Area 1"
 x="256"
 y="152"
 w="175"
 h="70"
 initvalue=""
 wordwrap="true"
 editable="true"
 bkcolor="0xFFFFFF"
  fontsize="12"
  fontname="Arial"
  fontcolor="0x000000"
></textarea>

<textarea
 name="My Text Area 2"
 x="158"
 y="340"
 w="434"
 h="85"
 initvalue=""
 wordwrap="true"
 editable="true"
 bkcolor="0xFFFFFF"
  fontsize="12"
  fontname="Arial"
  fontcolor="0x000000"
></textarea>

<label
 name="My Text 10"
 x="120"
 y="340"
 w="36"
 h="16"
 text="Order"
 fontbold="bold"
  fontname="Trebuchet MS"
  fontcolor="0x000000"
  fontsize="11"
></label>

</form>