Du kan tilrette denne til dit eget format :
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<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">
<HTML>
<HEAD>
<TITLE>
DOCUMENT TITLE
</TITLE>
<META HTTP-EQUIV="DESCRIPTION" CONTENT="">
<META HTTP-EQUIV="KEYWORDS" CONTENT="">
<META HTTP-EQUIV="GENERATOR" CONTENT="MPS HTMLGATE XP -
http://www.mpsoftware.dk"> </HEAD>
<BODY>
<H1>
<FONT FACE="Verdana" SIZE="2">Feedback</FONT>
</H1>
<HR WIDTH="90%" SIZE="1">
<P>
<FONT FACE="Verdana" SIZE="2">Tell us what you think about our web site, our products, our organization, or anything else that comes to mind. We welcome all of your comments and suggestions.</FONT>
</P>
<FORM ACTION="your_email@company.com" METHOD="post">
<P>
<FONT FACE="Verdana" SIZE="2">What kind of comment would you like to send?</FONT>
</P>
<DL>
<DD>
<FONT FACE="Verdana" SIZE="2"><INPUT TYPE="radio" NAME="MessageType" VALUE="Complaint">Complaint <INPUT TYPE="radio" NAME="MessageType" VALUE="Problem">Problem <INPUT TYPE="radio" CHECKED NAME="MessageType" VALUE="Suggestion">Suggestion <INPUT TYPE="radio" NAME="MessageType" VALUE="Praise </dl> <p><strong>What about us do you want to comment on?</strong></p> <dl> <dd><select name=" SIZE="1"> <SELECT SIZE="1">
<OPTION SELECTED>
Web Site
</OPTION>
<OPTION>
Company
</OPTION>
<OPTION>
Products
</OPTION>
<OPTION>
Store
</OPTION>
<OPTION>
Employee
</OPTION>
<OPTION>
(Other)
</OPTION>
</SELECT> Other: <INPUT TYPE="text" SIZE="26" MAXLENGTH="256" NAME="SubjectOther"></FONT>
</DD>
</DL>
<P>
<FONT FACE="Verdana" SIZE="2">Enter your comments in the space provided below:</FONT>
</P>
<DL>
<DD>
<FONT FACE="Verdana" SIZE="2">
<TEXTAREA NAME="Comments" ROWS="5" COLS="42">
</TEXTAREA></FONT>
</DD>
</DL>
<P>
<FONT FACE="Verdana" SIZE="2">Tell us how to get in touch with you:</FONT>
</P>
<DL>
<DD>
<PRE>
<FONT FACE="Verdana" SIZE="2">Name <INPUT TYPE="text" SIZE="35" MAXLENGTH="256" NAME="UserName">
E-mail <INPUT TYPE="text" SIZE="35" MAXLENGTH="256" NAME="UserEmail">
Tel <INPUT TYPE="text" SIZE="35" MAXLENGTH="256" NAME="UserTel">
FAX <INPUT TYPE="text" SIZE="35" MAXLENGTH="256" NAME="UserFAX"></FONT>
</PRE>
</DD>
</DL>
<DL>
<DD>
<FONT FACE="Verdana" SIZE="2"><INPUT TYPE="checkbox" NAME="ContactRequested" VALUE="ContactRequested"> Please contact me as soon as possible regarding this matter.</FONT>
</DD>
</DL>
<P>
<FONT FACE="Verdana" SIZE="2"><INPUT TYPE="submit" VALUE="Submit Comments"> <INPUT TYPE="reset" VALUE="Clear Form"></FONT>
</P>
</FORM>
</BODY>
</HTML>