<html>

<body>

<form>

<b>Tell us who you are:</b><br>

<input type="text" name="firstname" size="20" maxlength="35" value="First Name"/>

<input type="text" name="lastname" size="20" maxlength=“35" value="Last Name"/><br>

<p><b>Select the car type you prefer:</b><br>

<input type="checkbox" name="ctype" value="3d"/>

3-Door

<input type="checkbox" name="ctype" value="5d"/>

5-Door

<input type="checkbox" name="ctype" value="estate"/>

Esate <br>

<input type="checkbox" name="ctype" value="coupe"/>

Coupe/Sports

<input type="checkbox" name="ctype" value="jeep"/> 4x4 Off Road

</p>

<p>Choose the car manufacturer you prefer: <select name="cars">

<option value="volvo">Volvo</option>

<option value="saab">Saab</option>

<option value="fiat" selected="selected">Fiat</option>

<option value="audi">Audi</option>

</select></p>

<p><b>Would you like to be on our mailing list?</b><br>

<input type="radio" name="list" value="yes" checked/> Yes

<input type="radio" name="list" value="no"/> No

</p>

</form>

</body>

</html>