<FORM name="myform" action="parse.cgi" method="POST"> <TABLE border="1" cellspacing="3" cellpadding="5" width="350"> <TR> <TH bgcolor="cccccc">Title </TH> <TH bgcolor="cccccc">Copies </TH> <TH bgcolor="cccccc">Choice </TH> </TR> <TR> <TD>The Art of War </TD> <TD align="center">4 </TD> <TD align="center"> <INPUT type="radio" value="1" name="choice"> </TD> </TR> <TR> <TD>The Campaigns of Alexander </TD> <TD align="center">1 </TD> <TD align="center"> <INPUT type="radio" value="2" name="choice"> </TD> </TR> <TR> <TD>The Conquest of Gaul </TD> <TD align="center">3 </TD> <TD align="center"> <INPUT type="radio" value="3" name="choice"> </TD> </TR> <TR> <TD>The Unabomber's Manifesto </TD> <TD align="center">2 </TD> <TD align="center"> <INPUT type="radio" name="choice"> </TD> </TR> </TABLE><BR> <TABLE width="350" border="0"> <TR> <TD>Name: </TD> <TD> <INPUT type="Text" name="name" size="25" maxlength="25"> </TD> </TR> <TR> <TD>Address: </TD> <TD> <INPUT type="Text" name="address" size="25" maxlength="25"> </TD> </TR> <TR> <TD>City: </TD> <TD> <INPUT type="Text" name="city" size="15" maxlength="15"> </TD> </TR> <TR> <TD>State: </TD> <TD> <INPUT type="Text" name="state" size="2" maxlength="2"> </TD> </TR> <TR> <TD>Zip: </TD> <TD> <INPUT type="Text" name="zip" size="5" maxlength="5"> </TD> </TR> <TR> <TD>Phone: </TD> <TD> <INPUT type="Text" name="phone" size="12" maxlength="12"> </TD> </TR> </TABLE><BR> <INPUT type="submit" value="Submit"></FORM>