зеркало из https://github.com/mozilla/gecko-dev.git
217 строки
6.2 KiB
HTML
217 строки
6.2 KiB
HTML
<html>
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<body background="/media/bg.gif" bgcolor="#FFFFFF" text="#000000"
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link="#8000FF" vlink="#018B62" marginwidth="0" marginheight="0"
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topmargin="0" leftmargin="0">
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<form name="Registration">
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<input type="hidden" name="OpType" value=
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"register_household"><!--DLL: household information-->
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<!--DLL: shopper information-->
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<!--DLL: display state info-->
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<table width="610" cellspacing="0" cellpadding="0" border=
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"0">
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<tr>
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<td align="CENTER">
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<table width="540" cellspacing="0" cellpadding="2">
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</tr>
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<tr>
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<td align="right"><font
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color="#0000A0" size="3">First Name</font></td>
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<td colspan="2"><input type="text" name=
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"Name.First" maxlength="20" value="" size="30">
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<font color=
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"#008080" size="1">required</font></td>
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<td>
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</td>
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</tr>
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<tr>
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<td align="right"><font
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color="#0000A0" size="3">Last Name</font></td>
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<td colspan="2"><input type="text" name="Name.Last"
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value="" size="30"> <font
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color="#008080" size=
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"1">required</font></td>
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<td>
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</td>
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</tr>
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<tr>
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<td>
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</td>
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<td colspan="2"><font
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size="1" color=
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"#804040">This last name will appear on your
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household's coupons.</font></td>
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<td>
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</td>
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</tr>
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<tr>
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<td align="right"><font
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color="#0000A0" size="3">Gender</font></td>
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<td colspan="2"><nobr><input type="radio" name=
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"shGender" value="M"> male <input type="radio"
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name="shGender" value="F"> female <font
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color="#008080" size="1">
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required</font></nobr></td>
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<td>
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</td>
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</tr>
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<tr>
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<td>
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</td>
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</tr>
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<tr>
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<td align="right"><font
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color="#0000A0" size="3">Birthday</font></td>
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<td colspan="2"><nobr><input type="text" name=
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"Bdate" size="10" maxlength="20" value=
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"mm/dd/yyyy">
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<font
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color="#0000A0" size="3">
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Anniversary</font> <input type="text" name=
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"Anniv" size="10" maxlength="20"
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value="mm/dd/yyyy"></nobr> </td>
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<td>
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</td>
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</tr>
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<tr>
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<td>
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</td>
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<td colspan="2"><font
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size="1" color=
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"#804040">Special offers are posted for Birthdays
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and Anniversaries!</font></td>
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<td>
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</td>
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</tr>
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<tr>
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<td>
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</td>
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</tr>
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<tr>
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<td align="right"><font
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color="#0000A0" size="3">Address</font> </td>
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<td colspan="2"><input type="text" name=
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"Home.Street.Line1" value="" size="30"> <font
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size="1" color=
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"#804040">line 1</font></td>
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<td>
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</td>
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</tr>
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<tr>
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<td align="right">
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</td>
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<td colspan="2"><input type="text" name=
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"Home.Street.Line2" value="" size="30"> <font
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size="1" color=
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"#804040">line 2</font></td>
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<td>
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</td>
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</tr>
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<tr>
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<td align="right"><font
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color="#0000A0" size="3">City</font></td>
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<td colspan="2"><input type="text" name="Home.City"
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value="" size="20"> <font
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color="#008080" size=
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"1">required</font></td>
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<td>
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</td>
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</tr>
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<tr>
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<td align="right"><font
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color="#0000A0" size="3">State</font></td>
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<td colspan="2"><nobr><input type="text" name=
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"Home.State" value="" size="3" maxlength="4"> <font
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color="#008080"
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size="1">required </font>
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<font
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color="#0000A0" size="3">Zip
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Code</font> <input type="text" name="Home.PostalCode.Prefix"
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value="" size="6" maxlength="5"> <font
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color="#008080" size=
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"1">required</font></nobr></td>
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</tr>
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<tr>
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<td>
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</td>
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</tr>
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<tr>
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<td align="right"><font
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color="#0000A0" size="3">Home Area Code</font>
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</td>
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<td colspan="2"><input type="text" name=
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"Home.Phone.LocCode" value="" size="3" maxlength="3"> <font
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size="1" color=
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"#008080">required</font></td>
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</tr>
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<!--More to come in here-->
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<tr>
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<td>
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</td>
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</tr>
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<tr>
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<td align="right"><font
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color="#0000A0" size="3">e-mail</font></td>
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<td colspan="2"><nobr><input type="text" name=
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"Home.Email" value="" size="30"> <font
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color="#008080" size=
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"1">required</font></nobr></td>
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</tr>
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<tr>
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<td align="right"><font
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color="#0000A0" size="3"></font></td>
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<td colspan="2"><nobr><input type=submit value="submit">
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<font
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color="#008080" size=
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"1"></font></nobr></td>
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</tr>
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</table>
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</td>
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</tr>
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</table>
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</form>
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</body>
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</html>
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