<p>Tell us what you think about our web site, or 
anything else that comes to mind. We welcome all of your comments and 
suggestions.</p>
<form method="POST" action="--WEBBOT-SELF--">
	<!--webbot bot="SaveResults" u-file="_private/feedback.txt" s-format="TEXT/TSV" s-label-fields="TRUE" s-builtin-fields="Date Time REMOTE_NAME REMOTE_USER HTTP_USER_AGENT" s-form-fields -->
	<p><strong>What kind of comment would you like to send?</strong></p>
	<dl>
		<dd><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">Praise</dd>
	</dl>
	<p><strong>What about us do you want to comment on?</strong></p>
	<dl>
		<dd><select name="Subject" size="1">
		<option selected>Web Site</option>
		<option>(Other)</option>
		</select> Other:
		<input type="text" size="26" maxlength="256" name="SubjectOther"></dd>
	</dl>
	<p><strong>Enter your comments in the space provided below:</strong></p>
	<dl>
		<dd><textarea name="Comments" rows="5" cols="42"></textarea></dd>
	</dl>
	<p><strong>Tell us how to get in touch with you:</strong></p>
	<dl>
		<dd>
		<table>
			<tr>
				<td>Name</td>
				<td>
				<input type="text" size="35" maxlength="256" name="Username"></td>
			</tr>
			<tr>
				<td>E-mail</td>
				<td>
				<input type="text" size="35" maxlength="256" name="UserEmail"></td>
			</tr>
			<tr>
				<td>Tel</td>
				<td><input type="text" size="35" maxlength="256" name="UserTel"></td>
			</tr>
			<tr>
				<td>FAX</td>
				<td><input type="text" size="35" maxlength="256" name="UserFAX"></td>
			</tr>
		</table>
		</dd>
	</dl>
	<dl>
		<dd>
		<input type="checkbox" name="ContactRequested" value="ContactRequested"> 
		Please contact me as soon as possible regarding this matter.</dd>
	</dl>
	<p>
	  <input name="submit" type="submit" value="Submit Comments" />
	  <input type="reset" value="Clear Form"></p>
</form>