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<title>Acme, Inc. - Contact Information</title>
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<h2>Contact Us</h2>
<P>Just fill out the form below to send us your question or comment. We will be happy to respond if you so desire.</P>
<div align="center">
<form action="cgi-bin/feedback.cgi" method="post">
<table cellpadding=3 cellspacing=1 border=0 bgcolor="#006633" width="420">
<tr>
<td valign="top">
<div align="right"><b><font face="arial,helvetica" size="2" color="#FFFFFF">
Name:<br>
</font> </b></div>
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<input type="text" name="name" size=20 maxlength=40>
<br>
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<div align="right"><b><font face="arial,helvetica" size="2" color="#FFFFFF">
Email:<br>
</font> </b></div>
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<input type="text" name="email" size=20 maxlength=40>
<br>
</td>
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<tr>
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<div align="right"><b><font face="arial,helvetica" size="2" color="#FFFFFF">
Address:<br>
</font> </b></div>
</td>
<td valign="top" bgcolor="#FFFFFF">
<input type="text" name="address" size=20 maxlength=40>
<br>
</td>
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<tr>
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<div align="right"><b><font face="arial,helvetica" size="2" color="#FFFFFF">
Address 2:<br>
</font> </b></div>
</td>
<td valign="top" bgcolor="#FFFFFF">
<input type="text" name="address2" size=20 maxlength=40>
<br>
</td>
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<tr>
<td valign="top">
<div align="right"><b><font face="arial,helvetica" size="2" color="#FFFFFF">
City:<br>
</font> </b></div>
</td>
<td valign="top" bgcolor="#FFFFFF">
<input type="text" name="city" size=20 maxlength=40>
<br>
</td>
</tr>
<tr>
<td valign="top">
<div align="right"><b><font face="arial,helvetica" size="2" color="#FFFFFF">
State:<br>
</font> </b></div>
</td>
<td valign="top" bgcolor="#FFFFFF">
<input type="text" name="state" size=2 maxlength=2>
<br>
</td>
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<div align="right"><b><font face="arial,helvetica" size="2" color="#FFFFFF">
Zip Code:<br>
</font> </b></div>
</td>
<td valign="top" bgcolor="#FFFFFF">
<input type="text" name="zip" size=10 maxlength=10>
<br>
</td>
</tr>
<tr>
<td valign="top">
<div align="right"><b><font face="arial,helvetica" size="2" color="#FFFFFF">
Phone Number:<br>
<font size=1>(xxx-xxx-xxxx)<br>
</font> </font></b></div>
</td>
<td valign="top" bgcolor="#FFFFFF">
<input type="text" name="phone" size=15 maxlength=12>
<br>
</td>
</tr>
<tr>
<td valign="top">
<div align="right"><b><font face="arial,helvetica" size="2" color="#FFFFFF">
Fax Number:<br>
<font size=1>(xxx-xxx-xxxx)<br>
</font> </font></b></div>
</td>
<td valign="top" bgcolor="#FFFFFF">
<input type="text" name="fax" size=15 maxlength=12>
<br>
</td>
</tr>
<tr>
<td valign="top">
<div align="right"><b><font face="arial,helvetica" size="2" color="#FFFFFF">
Question/<br>
Comment:<br>
</font> </b></div>
</td>
<td valign="top" bgcolor="#FFFFFF">
<textarea name="comments" cols=30 rows=6 wrap="physical"></textarea>
<br>
</td>
</tr>
<tr bgcolor="#FFFFFF">
<td valign="top" colspan=2>
<div align="right">
<input type="submit" value="Submit">
<input type="reset" value="Reset Fields">
<br>
</div>
</td>
</tr>
</table>
</form>
</div>
</font></td>
</tr>
</table>
<br><br><br>
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