/*
JavaScript Unleashed, Third Edition
by Richard Wagner and R. Allen Wyke
ISBN: 067231763X
Publisher Sams CopyRight 2000
*/
<html>
<head><title>For More Information</title>
<SCRIPT LANGUAGE="JavaScript">
function checkType() {
if (document.form1.rush.checked) {
document.form1.action = "http://www.acadians.com/js/rush.cgi" }
}
</SCRIPT>
</head>
<body>
<h1>Order Form</h1>
<hr>
<form name="form1" action="http://www.acadians.com/js/order.cgi"
method="POST" onSubmit="checkType()">
<p>Please provide the following contact information:</p>
<blockquote>
<pre>
<em>First name </em>
<input type=text size=25 maxlength=256 name="Contact_FirstName">
<em>Last name </em>
<input type=text size=25 maxlength=256 name="Contact_LastName">
<em>Title </em>
<input type=text size=35 maxlength=256 name="Contact_Title">
<em>Organization </em>
<input type=text size=35 maxlength=256 name="Contact_Organization">
<em>Work Phone </em>
<input type=text size=25 maxlength=25 name="Contact_WorkPhone">
<em>FAX </em>
<input type=text size=25 maxlength=25 name="Contact_FAX">
<em>E-mail </em>
<input type=text size=25 maxlength=256 name="Contact_Email">
<em>URL </em><input type=text size=25 maxlength=25 name="Contact_URL">
</pre>
</blockquote>
<p>Please provide the following ordering information:</p>
<blockquote>
<pre>
<strong>QTY DESCRIPTION</strong>
<input type=text size=6 maxlength=6 name="Ordering_OrderQty0">
<input type=text size=45 maxlength=256 name="Ordering_OrderDesc0">
<input type=text size=6 maxlength=6 name="Ordering_OrderQty1">
<input type=text size=45 maxlength=256 name="Ordering_OrderDesc1">
<input type=text size=6 maxlength=6 name="Ordering_OrderQty2">
<input type=text size=45 maxlength=256 name="Ordering_OrderDesc2">
<input type=text size=6 maxlength=6 name="Ordering_OrderQty3">
<input type=text size=45 maxlength=256 name="Ordering_OrderDesc3">
<input type=text size=6 maxlength=6 name="Ordering_OrderQty4">
<input type=text size=45 maxlength=256 name="Ordering_OrderDesc4">
<strong>BILLING</strong>
<em>Purchase order # </em>
<input type=text size=25 maxlength=256 name="Ordering_PONumber">
<em>Account name </em>
<input type=text size=25 maxlength=256 name="Ordering_POAccount">
<strong>SHIPPING</strong>
<em> Street address </em>
<input type=text size=35 maxlength=256 name="Ordering_StreetAddress">
<em> Address (cont.) </em>
<input type=text size=35 maxlength=256 name="Ordering_Address2">
<em>City </em>
<input type=text size=35 maxlength=256 name="Ordering_City">
<em> State/Province </em>
<input type=text size=35 maxlength=256 name="Ordering_State">
<em> Zip/Postal code </em>
<input type=text size=12 maxlength=12 name="Ordering_ZipCode">
<em> Country </em>
<input type=text size=25 maxlength=256 name="Ordering_Country">
</pre>
<pre>
<input type=checkbox name="rush" value="ON">Rush Order!
</pre>
</blockquote>
<p>
<input type=submit value="Submit Form">
<input type=reset value="Reset Form">
</p>
</form>
</body>
</html>
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