<form method=POST action="/cgi-bin/cgiemail/mail.txt">
<INPUT TYPE=HIDDEN VALUE="http://AllWebCo.com/manual/success.html" name="success">
<INPUT TYPE=HIDDEN VALUE="spammers@fax.com" name="required-to">
<INPUT TYPE=HIDDEN VALUE="Addition to THE LIST" name="subject">

Company Name<br>
<input type=text size=60 name="company" value=""><p>
Area/Country codes<br>
<textarea name="area" value="" rows=2 cols=60></textarea><P>
Local Area codes (foreign countries only)<br>
<textarea name="local" value="" rows=2 cols=60></textarea><P>
Automated email address<br>
<input type=text size=60 name="automated" value=""><p>
Human email address<br>
<input type=text size=60 name="username" value=""><p>
Phone<br>
<input type=text size=60 name="phone" value=""><p>
Fax<br>
<input type=text size=60 name="fax" value=""><p>
URL<br>
<input type=text size=60 name="url" value=""><p>
Services<br>
<textarea name="services" value="" rows=14 cols=70></textarea><P>
Fees<br>
<textarea name="fees" value="" rows=14 cols=70></textarea><P>
Notes<br>
<textarea name="notes" value="" rows=4 cols=70></textarea><P>

<input type=submit value="SUBMIT"> <input type=reset value="START OVER!"><p>
</form>