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<TITLE>Talk To Us</TITLE>
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<Div class=CenteredTitle>Computer Discount House</div>
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<FORM METHOD="POST" ACTION="/cgidev2p/template3.pgm">
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Computer Discount House would be happy to send you further information on its products
and services. Please complete the following FORM or call 1-800-555-0000
<P>
What is your name?..........................
<INPUT NAME="custname" SIZE="40" MAXLENGTH="40">
<P>
What is your E-mail address?............
<INPUT NAME="emailadd" SIZE="40" MAXLENGTH="40">
<P>
What state do you live in?.................
<SELECT NAME="state">
<OPTION VALUE="AL">Alabama
<OPTION VALUE="AK">Alaska
<OPTION VALUE="AZ">Arizona
<OPTION VALUE="AR">Arkansas
<OPTION VALUE="CA">California
<OPTION VALUE="CO">Colorado
<OPTION VALUE="CT">Connecticut
<OPTION VALUE="DC">District of Columbia
<OPTION VALUE="DE">Delaware
<OPTION VALUE="FL">Florida
<OPTION VALUE="GA">Georgia
<OPTION VALUE="HI">Hawaii
<OPTION VALUE="ID">Idaho
<OPTION VALUE="IL">Illinois
<OPTION VALUE="IN">Indiana
<OPTION VALUE="IA">Iowa
<OPTION VALUE="KS">Kansas
<OPTION VALUE="KY">Kentucky
<OPTION VALUE="LA">Louisiana
<OPTION VALUE="ME">Maine
<OPTION VALUE="MD">Maryland
<OPTION VALUE="MA">Massachusetts
<OPTION VALUE="MI">Michigan
<OPTION VALUE="MN">Minnesota
<OPTION VALUE="MS">Mississippi
<OPTION VALUE="MO">Missouri
<OPTION VALUE="MT">Montana
<OPTION VALUE="NC">North Carolina
<OPTION VALUE="ND">North Dakota
<OPTION VALUE="NE">Nebraska
<OPTION VALUE="NH">New Hampshire
<OPTION VALUE="NJ">New Jersey
<OPTION VALUE="NM">New Mexico
<OPTION VALUE="NV">Nevada
<OPTION VALUE="NY">New York
<OPTION VALUE="OH">Ohio
<OPTION VALUE="OK">Oklahoma
<OPTION VALUE="OR">Oregon
<OPTION VALUE="PA">Pennsylvania
<OPTION VALUE="PR">Puerto Rico
<OPTION VALUE="RI">Rhode Island
<OPTION VALUE="SC">South Carolina
<OPTION VALUE="SD">South Dakota
<OPTION VALUE="TN">Tennesee
<OPTION VALUE="TX">Texas
<OPTION VALUE="UT">Utah
<OPTION VALUE="VT">Vermont
<OPTION VALUE="VA">Virginia
<OPTION VALUE="WA">Washington
<OPTION VALUE="WV">West Virginia
<OPTION VALUE="WI">Wisconsin
<OPTION VALUE="WY">Wyoming
<OPTION VALUE="XX">Other
</SELECT>
<P>
How many years have you lived there? (e.g. 12.25)
<INPUT NAME="years" SIZE="6" MAXLENGTH="6">
<P>
<HR>
<H3>Help Us Serve You Better</H3>
Have you ordered from us before?
<P>
<INPUT TYPE="RADIO" NAME="ordered" VALUE="1">YES
<INPUT TYPE="RADIO" NAME="ordered" VALUE="2">NO
<P>
Have you ever received a CATALOG from Computer Discount House?
<P>
<INPUT TYPE="RADIO" NAME="catalog" VALUE="1">YES
<INPUT TYPE="RADIO" NAME="catalog" VALUE="2">NO
<P>
With which operating system environments have you worked?
<P>
<SELECT MULTIPLE NAME="os" SIZE="16">
<OPTION VALUE="IBM AIX">IBM AIX
<OPTION VALUE="IBM CMS">IBM CMS
<OPTION VALUE="IBM MVS">IBM MVS
<OPTION VALUE="IBM OS/2">IBM OS/2
<OPTION VALUE="IBM OS/400">IBM OS/400
<OPTION VALUE="IBM PC DOS">IBM PC DOS
<OPTION VALUE="Linux">Linux
<OPTION VALUE="MS DOS">Microsoft DOS
<OPTION VALUE="MS Windows 3.X">Microsoft Windows 3.X
<OPTION VALUE="MS Windows/95">Microsoft Windows/95
<OPTION VALUE="MS Windows/NT">Microsoft Windows/NT
<OPTION VALUE="other UNIX">Another UNIX-based OS
<OPTION VALUE="other mainframe">Another mainframe-based OS
<OPTION VALUE="other midrange">Another midrange-based OS
<OPTION VALUE="other PC">Another PC-based OS
<OPTION VALUE="something else">Something else
</SELECT>
<HR>
<INPUT TYPE="SUBMIT" VALUE="Press Here to Send">
<INPUT TYPE="RESET" VALUE="Press Here to Clear">
</FORM>
<P>
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