Form Sample 1

Here is a nice simple email form using a coloured background to help show the different features more clearly. It utilizes most of the elements covered in these lessons. Just have a look at the source code if you want to see how it is done.Click your BACK button to return.


The Shoppers' Survey

Another Rosie Brown Production


Please complete the form below to be in the draw for valuable prizes. All winners will be notified by email.
You can see full details by visiting the Prize Page.

* = required



* Name (First & Surname):

* Location (City/Town):

* Email address:

Home Phone:

Work Phone:

How many times a week do you shop?
1   2   3   More than three

Select your favourite supermarket:

Give a brief reason why you prefer your choice:

Which day(s) do you prefer to shop?
Mon   Tues   Wed   Thurs   Fri   Sat  

* Would you use all night shopping if available in your area?
Yes   No

What is your family income bracket:


Back to Forms 1   |   Back to Forms 3