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    Customer survey name: address: email: zip / postal code: country: united states philippines japan thailand gender: female male lesbian gay nickname: contact no: birth date: january february march april day: 1 2 3 4 5 year: 2001 2002 2003 2004 education: - - select education position: how did you hear about our sites? entertainment sweepstakes and free stuff music.

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    Customer survey name: address: email: zip / postal code: country: united states philippines japan thailand gender: female male lesbian gay nickname: contact no: birth date: january february march april day: 1 2 3 4 5 year: 2001 2002 2003 2004 education: - - select education position: how did you hear about our sites? entertainment sweepstakes and free stuff music.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as TXT, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    20 views3 pages

    Customer Survey

    Uploaded by

    api-3738474
    Customer survey name: address: email: zip / postal code: country: united states philippines japan thailand gender: female male lesbian gay nickname: contact no: birth date: january february march april day: 1 2 3 4 5 year: 2001 2002 2003 2004 education: - - select education position: how did you hear about our sites? entertainment sweepstakes and free stuff music.

    Copyright:

    Attribution Non-Commercial (BY-NC)
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    of 3

    <html>

    <head><title> customer survey </title></head>

    <body>
    <table align=center>
    <tr>
    <td><img src="c:\documents and settings\student\desktop\bean.jpg"></td>
    <td><font color="gray" size="5">customer survey</font></center></td>
    </tr>
    </table>

    <hr>

    <center>
    name: <input type=text name=tukmol size=30 value="facifica falayfay" >
    address: <input type=text name=tukmol size=30 value="abc@yahoo.com" >
    email: <input type=text name=tukmol size=30 value="abc@yahoo.com" >
    </center>

    <br>

    <table align=center><p>
    zip/postal code: <input type=text name=tukmol size=10 value="- -" >

    country: <select name=country size=1>


    <option value=country>united states
    <option value=country>philippines
    <option value=country>japan
    <option value=country>thailand
    </select>

    gender: <select name=country size=1>


    <option value=gender>female
    <option value=gender>male
    <option value=gender>lesbian
    <option value=gender>gay
    </select>

    nickname: <input type=text name=tukmol size=10 value="- -" >


    contact no: <input type=text name=tukmol size=10 value="- -" >

    <br>
    <center>

    birth date: month: <select name=month size=1>


    <option value=month>january
    <option value=month>february
    <option value=month>march
    <option value=month>april
    </select>

    day: <select name=month size=1>


    <option value=day>1
    <option value=day>2
    <option value=day>3
    <option value=day>4
    <option value=day>5
    <option value=day>6
    <option value=day>7
    <option value=day>8
    <option value=day>9
    <option value=day>0
    </select>

    year: <select name=year size=1>


    <option value=year>2001
    <option value=year>2002
    <option value=year>2003
    <option value=year>2004
    </select>
    </center>

    <br>

    <center>
    education: <select name=education size=1>
    <option value=education>- - select education
    </select>

    education: <select name=position size=1>


    <option value=position>- - select position
    </select>
    </center>

    <br>
    <center>
    how did you hear about our sites?
    </center>

    <br>

    <center>
    <form>
    <input type="radio" name="jm" value=web>web
    <input type="radio" name="jm" value=magazine>magazine
    <input type="radio" name="jm" value=radio checked>radio
    <input type="radio" name="jm" value=television>television
    </form>
    </center>

    <br>

    <center>
    your interest: (pls. check any of the following)
    </center>

    <center>
    <table border="3">
    <td>

    <form>
    <input type="checkbox" name="jm" value=entertainment>entertainment<br>
    <input type="checkbox" name="jm" value=sweepstakes and free stuff
    checked>sweepstakes and free stuff<br>
    <input type="checkbox" name="jm" value=music>music
    <form>
    </td>

    <td>
    <form>
    <input type="checkbox" name="jm" value=computer and technology
    checked>computer and technology<br>
    <input type="checkbox" name="jm" value=shopping>shopping<br>
    <input type="checkbox" name="jm" value=personal finance>personal
    finance
    <form>
    </td>

    <td>

    <form>
    <input type="checkbox" name="jm" value=small business and
    entreprenuer>small business and entreprenuer<br>
    <input type="checkbox" name="jm" value=sports outdoors checked>sports
    outdoors<br>
    <input type="checkbox" name="jm" value=travel>travel
    <form>

    </td>
    </table>
    </center>

    <center>
    any comment, suggestion or feedback:
    </center>

    <center>
    <p><textarea rows=10 col=10>
    </textarea>
    </center>

    </table>

    </body>

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