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<html>

<head>

<title>Hi-Tech Order Form</title>

</head>

<body>

<form>

<p align=center>

<font size=+3>Hi-Tech Order Form</font>

</p>

Name:

<table border=0>

<tr>

<td><input type="text"

</tr>

</table>

<br>

Type of order:<br>

<input type="radio" name="take out">take out<br>

<input type="radio" name="eat here">eat here<br>

<br>

<select>

<option value="hot dog">hot dog</option>

<option value="Burger">Burger</option>

<option value="Sandwich">Sandwich</option>

</select>
<br><br>

What else would you like?

<br>

<input type="checkbox" name="iced tea" value="yes"> iced tea

<br>

<input type="checkbox" name"french fries" value="yes"> french fries

<br><br>

<textarea name="comments" rows=5 cols=40 wrap="yes">

Special instructions:

</textarea>

<br><br>

<input type="Submit" value="Submit the Order">

<br>

<input type="Reset" value="Reset - Try Again">

</form>

</body>

</html>

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