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| PRODUCT REQUEST | EMAIL | | | | | | | | | | | ID | Name | Type | * | Features | Size | Length | Options | Min | Max | | | | formname | SAMPLE PRODUCT REQUEST FORM | HIDDEN | | * | | | | | | | | | autodate | | HIDDEN | | | datetime | | | | | | | | autoip | | HIDDEN | | | ip | | | | | | | | autohost | | HIDDEN | | | host | | | | | | | | autoagent | | HIDDEN | | | agent | | | | | | | | company | Company | TEXT | | | 60 | 180 | required,separate | 2 | 180 | | | | name | Name and surname | TEXT | | | 60 | 180 | required,separate | 2 | 180 | | | | city | City | TEXT | | | 60 | 180 | required | 2 | 180 | | | | country | Country | SELECT | | required,other | 34 | 120 | Germany | England | Canada | United States | other | | e-mail | E-mail | TEXT | | | 40 | 180 | required,email | 2 | 180 | | | | invoicedelivery | Invoice Delivery | RADIO | | required | oneline | mail | telefax | e-mail (pdf file) | | | | | order |
SELECT PRODUCT AND DELIVERY METHOD
(no real obligations are required from you - this is a sample) | HIDDEN | | | | | | | | | | | line1 | Wild West Wind 8.0 | ORDERLINE | | Price € | 2 | (120+120/x.line1xx1.value)*x.line1xx1.value; if(x.line1.status)x.line1xx1.value=Math.min(50,Math.max(1,x.line1xx1.value)); | Licences (1..50) | | | | | | line2 | CD-ROM/Delivery | ORDERLINE | | Price € | 4 | 30*x.line2.status/x.line2.status*x.line1.status/x.line1.status | | | | | | | xmmxxtotalamount | Total amount € | ORDERTOTAL | | required | 12 | 0.16 | 16% VAT € | Net amount € | Calculate | | | | questions | Do you have any questions, comments, wishes? | TEXTAREA | | | 60 | 8 | | 10 | 20000 | | | | newsletter | I/We agree to receive Newsletters | CHECKBOX | | checked,br,before | | | | | | | | | submit | SUBMIT | SUBMIT | | | | | | | | | | | reset | Reset | RESET | | | | | | | | | | | print | Print | PRINT | | | | | | | | | |
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