<!--The following form uses a RPG CGI Program to -->
<!--process the input data. -->
<form action="/BonusCGI/imvr501.PGM" METHOD="POST">
<p>Please provide the following information:</p>
<b>
<pre>
Name <input type=text size=25 maxlength=25 name="FNAME">
E-mail <input type=text size=25 maxlength=30 name="EMAIL">
Street address <input type=text size=25 maxlength=25 name="ADDRESS1">
Address (cont.) <input type=text size=25 maxlength=25 name="ADDRESS2">
City <input type=text size=25 maxlength=25 name="CITY">
State/Province <input type=text size=3 maxlength=3 name="STATE">
Zip/Postal code <input type=text size=12 maxlength=12 name="ZIPCODE">
Country <input type=text size=25 maxlength=25 name="COUNTRY">
Phone Number <input type=text size=14 maxlength=14 name="PHONE">
Comments <textarea name="COMMENT" rows=5 cols=42></textarea>
</pre></b>
<p><input type=submit value="Submit Form">
<input type=reset value="Clear Form"> </p>
</form>
CGI020