Make Customized Form for form.pl

your customized maker
intro | demo | place your order | faq | tech support

STEP 1 fill in your name here
STEP 2 indicate your choices below
STEP 3 when finished, press NEXT at bottom

URL of logo graphic you want displayed instead of
(if left blank the above grahic will be displayed)
http://

Capitola Works
name of company you want here
(instead of Capitola Works)

what product choices you want
to offer?
If you need more than 5, you realy need our shopping cart!

product 1
product 2
product 3
product 4
product 5

do you want to offer these with a
check box (allows customer to select more than one or any of the products on your form)
or
radio button (allows customer to select only one of the products on your form)

type below the name you want for each field on your customized form (a field left blank will not show on your customized form)

field 1

i.e. name

field 2

i.e. e-mail

field 3

i.e. phone

field 4

i.e. fax

field 5

i.e. address

field 6

i.e. city

field 7

i.e. state

field 8

i.e. zip code

field 9

i.e. country

field 10

i.e. comment or message box

field 11

i.e. color of hair?

field 12

i.e. sexual preference?

YES
NO

indicate here if you want the below credit card info gathering form included on your customized order form

if you answered YES above
indicate which credit card options you want to offer

American Express
Discover
Master Card
VISA
other

If you want color coordination with another of your pages fill in that page's URL
(we'll design your customized form to fit seamlessly with your site)
http://

Any additional instructions?

will take you to STEP 3 to design the THANK YOU page intro | demo | place your order | faq | tech support