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Displaying  Source Code(s)  
 

 
User registration Form using Java Script.

--------------------------------------------------------------------------------

Description : This is a sample user registration form using JavaScript. Here student Radio button specially for our college Jalpaiguri Govt. Engg.College. I add this code because user can understand simple use of form elements. User can also select general radio field for general use.

<html>
<head>
<title>User Registration Form</title>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1">

<script language="JavaScript" fptype="dynamicanimation">

<!--
function dynAnimation() {}
function clickSwapImg() {}
//-->
</script>
<script language="JavaScript1.2" fptype="dynamicanimation"
src="file:///C:/Program%20Files/Microsoft%20Office/Office10/fpclass/animate.js">
</script>

</head>

<body onload="dynAnimation()">

<script language="javascript">

function verify(form) <!-- verify()
function start here-->
{
if(document.forms[0].elements[0].value=="")
{
alert("Please Enter User ID");
document.forms[0].elements[0].focus();
return(false);
}
if(document.forms[0].elements[1].value=="")
{
alert("Please Enter your Password");
document.forms[0].elements[2].value="";
document.forms[0].elements[1].focus();
return(false);
}
if(document.forms[0].elements[1].value.length<4)
{
alert("Password must be greater than 4 character");
document.forms[0].elements[1].value="";
document.forms[0].elements[2].value="";
document.forms[0].elements[1].focus();
return(false);
}

if(document.forms[0].elements[2].value=="")
{
alert("Please Enter your Confirm Password");
document.forms[0].elements[2].focus();
return(false);
}
<!-- Checking of Password and ConfirmPassword's Equality -->


if((document.forms[0].elements[1].length)!=(document.forms[0].elements[2].
length))
{
alert("Your Password does not match with Confirm Password");
document.forms[0].elements[1].value="";
document.forms[0].elements[2].value="";
document.forms[0].elements[1].focus();
return(false);
}

if((document.forms[0].elements[1].length)==(document.forms[0].elements[2].
length))
{

if((document.forms[0].elements[1].value)!=(document.forms[0].elements[2].v
alue))
{
alert("Your Password does not match with Confirm Password");
document.forms[0].elements[1].value="";
document.forms[0].elements[2].value="";
document.forms[0].elements[1].focus();
return(false);
}
}
if(document.forms[0].elements[3].value=="secq")
{
alert("Please Select your Security Question");
document.forms[0].elements[3].focus();
return(false);
}
if(document.forms[0].elements[4].value=="")
{
alert("Please Answer the security question");
document.forms[0].elements[4].focus();
return(false);
}
if(document.forms[0].elements[5].value=="DD")
{
alert("Please select Day of DOB");
document.forms[0].elements[5].focus();
return(false);
}
if(document.forms[0].elements[6].value=="MM")
{
alert("Please select Month of DOB");
document.forms[0].elements[6].focus();
return(false);
}
if(document.forms[0].elements[7].value=="YYYY")
{
alert("Please select Year of DOB");
document.forms[0].elements[7].focus();
return(false);
}


if(document.forms[0].elements[10].checked==true)
<!-- Check student info if checked ::if Loop start here-->
{
if(document.forms[0].elements[11].value=="")
{
alert("Please Enter your First Name");
document.forms[0].elements[11].focus();
return(false);
}
if(document.forms[0].elements[13].value=="")
{
alert("Please Enter your Last Name");
document.forms[0].elements[13].focus();
return(false);
}
if(document.forms[0].elements[14].value=="Year")
{
alert("Please specify your Academic year");
document.forms[0].elements[14].focus();
return(false);
}

if(document.forms[0].elements[15].value=="adminyear")
{
alert("Please put your Admission Year");
document.forms[0].elements[15].focus();
return(false);
}
if(document.forms[0].elements[16].value=="dept")
{
alert("Please Select your Department");
document.forms[0].elements[16].focus();
return(false);
}

if(document.forms[0].elements[17].value=="")
{
alert("Please put your Roll Number");
document.forms[0].elements[17].focus();
return(false);
}


if(document.forms[0].elements[17].value!="")
<!-- Check Roll No field If Loop-->
{
r0=document.forms[0].elements[17].value.indexOf('2');
r1=document.forms[0].elements[17].value.indexOf('k');
r2=parseInt(document.forms[0].elements[17].value.charAt(2));
r3=document.forms[0].elements[17].value.indexOf('_');
r4=parseInt(document.forms[0].elements[17].value.charAt(4));
r5=parseInt(document.forms[0].elements[17].value.charAt(5));
r6=parseInt(document.forms[0].elements[17].value.charAt(6));

len=document.forms[0].elements[17].value.length;

if((len!=7)||(r0!=0)||(r1!=1)||(r3!=3)||(r4>6 || r4<1)||(r2>9 || r2<1))
{
alert("Not a valid Roll Number");
document.forms[0].elements[17].focus();
return(false)
}

<!--Verify Department with Roll No-->

switch(document.forms[0].elements[16].value)
{
case 'IT':
if(r4!=6||(r5>4||r5<0)||(r6>9||r6<0))
{
alert("Not a valid Roll Number of Information Technology");
document.forms[0].elements[16].focus();
return(false)
}break;
case 'CSE':
if(r4!=5||(r5>4||r5<0)||(r6>9||r6<0))
{
alert("Not a valid Roll Number of Computer Science");
document.forms[0].elements[16].focus();
return(false)
}break;
case 'ECE':
if(r4!=4||(r5>4||r5<0)||(r6>9||r6<0))
{
alert("Not a valid Roll Number of Electronics");
document.forms[0].elements[16].focus();
return(false)
}break;
case 'EE':
if(r4!=2||(r5>6||r5<0)||(r6>9||r6<0))
{
alert("Not a valid Roll Number of Electrical Engineering");
document.forms[0].elements[16].focus();
return(false)
}break;
case 'ME':
if(r4!=3||(r5>6||r5<0)||(r6>9||r6<0))
{
alert("Not a valid Roll Number of Mechanical Engineering");
document.forms[0].elements[16].focus();
return(false)
}break;
case 'CE':
if(r4!=1||(r5>6||r5<0)||(r6>9||r6<0))
{
alert("Not a valid Roll Number of Civil Engineering");
document.forms[0].elements[16].focus();
return(false)
}break;
}<!--End of Switch 1-->

<!--Verify Department with Year-->


switch(document.forms[0].elements[14].value)
{
case 'Fourth':
if(r2!=1||(r2>9||r2<0))
{
alert("Not a valid Roll Number of Forth Year");
document.forms[0].elements[14].focus();
return(false)
}break;
case 'Third':
if(r2!=2||(r2>9||r2<0))
{
alert("Not a valid Roll Number of Third Year");
document.forms[0].elements[14].focus();
return(false)
}break;
case 'Second':
if(r2!=3||(r2>9||r2<0))
{
alert("Not a valid Roll Second Year");
document.forms[0].elements[14].focus();
return(false)
}break;
case 'First':
if(r2!=4||(r2>9||r2<0))
{
alert("Not a valid Roll Number of First Year");
document.forms[0].elements[14].focus();
return(false)
}break;

} <!--End of Switch 2-->


} <!--End of Roll No field If Loop-->



if(document.forms[0].elements[17].value!="selecthostel")
<!--Check Gender with Hostel::Loop Start-->
{

if((document.forms[0].elements[8].checked==true)&&(document.forms[0].elements[18].value=="LH"))
{
alert("You are Male user::Please select Boys Hostel");
document.forms[0].elements[18].focus();
return(false);
}

if((document.forms[0].elements[9].checked==true)&&(document.forms[0].elements[18].value!="LH"))
{
alert("You are Female user::Please select L.H.");
document.forms[0].elements[18].focus();
return(false);
}

} <!--Check Gender with Hostel::Loop End-->


} <!-- Check student info if checked ::if Loop End here-->


if(document.forms[0].elements[24].checked==true)
<!-- Check General info if checked:: if Loop start here-->
{
if(document.forms[0].elements[25].value=="")
{
alert("Please Enter Your First Name");
document.forms[0].elements[25].focus();
return(false);
}
if(document.forms[0].elements[27].value=="")
{
alert("Please Enter your Last Name");
document.forms[0].elements[27].focus();
return(false);
}
if(document.forms[0].elements[30].value=="state")
{
alert("Please Select Your State");
document.forms[0].elements[30].focus();
return(false);
}
if(document.forms[0].elements[31].value=="country")
{
alert("Please Select Your State");
document.forms[0].elements[31].focus();
return(false);
}


if((document.forms[0].elements[32].value=="pincode")||(document.forms[0].elements[33].value=""))
{
alert("Please Select Your Pincode OR if Other specify");
document.forms[0].elements[32].focus();
return(false);
}

} <!-- Check General info if checked ::if Loop end here-->


} <!-- End verify() function-->

function studentclear(form)
{
document.forms[0].elements[11].value="";
document.forms[0].elements[12].value="";
document.forms[0].elements[13].value="";
document.forms[0].elements[14].value="Year";
document.forms[0].elements[15].value="adminyear";
document.forms[0].elements[16].value="dept";
document.forms[0].elements[17].value="";
document.forms[0].elements[18].value="selecthostel";
document.forms[0].elements[19].value="";
document.forms[0].elements[20].value="";
document.forms[0].elements[21].value="";
document.forms[0].elements[22].value="";
document.forms[0].elements[23].value="";
document.forms[0].elements[25].focus();
}
function generalclear(form)
{
document.forms[0].elements[25].value="";
document.forms[0].elements[26].value="";
document.forms[0].elements[27].value="";
document.forms[0].elements[28].value="City";
document.forms[0].elements[29].value="";
document.forms[0].elements[30].value="state";
document.forms[0].elements[31].value="country";
document.forms[0].elements[32].value="pincode";
document.forms[0].elements[33].value="";
document.forms[0].elements[34].value="";
document.forms[0].elements[35].value="";
document.forms[0].elements[36].value="";
document.forms[0].elements[37].value="";
document.forms[0].elements[11].focus();
}

</script>

<body onLoad=document.forms[0].elements[0].focus();>

<form action ="" method="post" onsubmit="return verify(this.form)">

<center>
<p dynamicanimation="fpAnimelasticRightFP1" id="fpAnimelasticRightFP1"
style="position: relative !important; visibility: hidden" language="Javascript1.2">
<font size="6" face="Monotype Corsiva" color="#800000">New User Registration Form</font></p>
</center><br>
<i><font color="#FF0000"><font face="Arial" size="4">











*
</font><font face="Arial" size="2">
</font> </font>

<font face="Arial" size="2"color="#FF0000">
Indicates all the fields are mandatory</font></i><hr><p>
<font size="4" face="Arial, Helvetica, sans-serif" color="#FF0000">
*</font><font size="-1" face="Arial, Helvetica,sans-serif">

User ID:
</font><b>

<!--webbot bot="Validation" s-data-type="String" b-allow-letters="TRUE"
b-allow-digits="TRUE" s-allow-other-chars="_"
b-value-required="TRUE" i-minimum-length="4" i-maximum-length="15" -->

<input name="uid" size="16" maxlength="15">
</b><font color="#FF0033" size="2"> </font><font face="Arial" size="2" color="#FF0033">
(Contains only letters (a-z), numbers (0-9) and underscore)</font><br>




<b><br>
</b>

<font size="4" face="Arial, Helvetica, sans-serif" color="#FF0000">*
</font>

<font size="-1" face="Arial, Helvetica,sans-serif">
Password:
</font>

<font color="#000000"> </font>
<input type="password" name="pswd" size="9" maxlength="10"
style="font-weight: bold; color:#008000">
<font color="#000000"size="2">
<font face="Arial"> </font></font><font
color="#FF0033"
size="2" face="Arial">
(Password should be of minimum 4(four) and maximum 10(ten)
characters.</font><font size="2"><font color="#FF0033"
face="Arial">)</font></p>
</font> <font face="ARIAL, HELVETICA"
size="-1"> </font>
<font size="4" face="Arial, Helvetica, sans-serif"
color="#FF0000">*</font><font face="ARIAL, HELVETICA" size="-1">Re-Type
Password</font>:<font size="2"> <b>

<input type="password" name="cpswd" size="11"
maxlength="10"
style="color:#008000" >
</b> </font>
<hr>
<font size="2"> </font><font size="2"> <font
face="Arial, Helvetica, sans-serif">
<i>If you forget your password, you can retrieve it by
answering
your
unique hint question. <br>
Frame your question such that only you know
its answer.
</i></font></font>
<div align="center"><font face="Arial" size="2"></font><font
face="Arial" size="2"></font><font face="Arial" size="2"></font><font
face="Arial" size="2">

</font></div>
<font face="Arial" size="2"><br>
</font><font size="2"><font face="Arial"><font face="Arial,
Helvetica, sans-serif">
</font></font></font><font
size="4" face="Arial, Helvetica, sans-serif"
color="#FF0000">*</font><font
size="2"><font face="Arial"><font face="Arial, Helvetica,
sans-serif">Select
a question forgetting password
</font><b>: </b></font><select size="1" name="secq">
<option selected value="secq">Select a hit question
?</option>
<option value="What is your favourite multimedia
software?">What is your favourite multimedia software?</option>

<option value="What is your favourite game?">What is your
favourite game?</option>
<option value="who is your favourite Cricketer?">who is
your
favourite Cricketer?</option>
<option value="who is your favourite Film Actor?">who is
your
favourite Film Actor?</option>
<option value="what is your favourite food?">what is your
favourite food?</option>
</select><font face="Arial"><b>
</b></font>
</font><p><font
size="2">

</font>
<font size="4" face="Arial, Helvetica, sans-serif"
color="#FF0000">*</font><font color="#000000" face="Arial, Helvetica,
sans-serif" size="2">Hit

Answer:



<input type="text" name="seca" size="21"> </font>
<font size="2"><font color="#000000" face="Arial,
Helvetica,
sans-serif"> </font><font color="#FF0033"
face="Arial">(Write

Your Answer)</font><font color="#000000" face="Arial">
</font>
</font><font size="1"></p>
</font>
<hr>

<div align="left"> <font face="Arial,
Helvetica, sans-serif" size="-1">





DD

MM
YYYY <br>

</font>
<font size="4" face="Arial, Helvetica, sans-serif"
color="#FF0000">

*</font><font face="Arial, Helvetica, sans-serif"
size="-1">Date
of Birth:

<select size="1" name="DD">
<option selected value="DD">Day</option>
<option value="1">1</option>
<option value="2">2</option>

<option value="3">3</option>
<option value="4">4</option>
<option value="5">5</option>
<option value="6">6</option>
<option value="7">7</option>
<option value="8">8</option>

<option value="9">9</option>
<option value="10">10</option>
<option value="11">11</option>
<option value="12">12</option>
<option value="13">13</option>
<option value="14">14</option>

<option value="15">15</option>
<option value="16">16</option>
<option value="17">17</option>
<option value="18">18</option>
<option value="19">19</option>
<option value="20">20</option>

<option value="21">21</option>
<option value="22">22</option>
<option value="23">23</option>
<option value="24">24</option>
<option value="25">25</option>
<option value="26">26</option>

<option value="27">27</option>
<option value="28">28</option>
<option value="29">29</option>
<option value="30">30</option>
<option value="31">31</option>
</select>

<select size="1" name="MM">
<option selected value="MM">Month</option>
<option value="JANUARY">JAN</option>
<option value="FEBRUARY">FEB</option>
<option value="MARCH">MAR</option>
<option value="APRIL">APR</option>

<option value="MAY">MAY</option>
<option value="JUNE">JUN</option>
<option value="JULY">JUL</option>
<option value="AUGUST">AUG</option>
<option value="SEPTEMBER">SEP</option>
<option value="OCTOBER">OCT</option>

<option value="NOVEMBER">NOV</option>
<option value="DECEMBER">DEC</option>
</select>
<select size="1" name="YYYY">
<option selected value="YYYY">Year</option>
<option value="1970">1970</option>
<option value="1971">1971</option>

<option value="1972">1972</option>
<option value="1973">1973</option>
<option value="1974">1974</option>
<option value="1975">1975</option>
<option value="1976">1976</option>
<option value="1977">1977</option>

<option value="1978">1978</option>
<option value="1979">1979</option>
<option value="1980">1980</option>
<option value="1981">1981</option>
<option value="1982">1982</option>
<option value="1983">1983</option>

<option value="1984">1984</option>
<option value="1985">1985</option>
<option value="1986">1986</option>
<option value="1987">1987</option>
<option value="1988">1988</option>
<option value="1989">1989</option>

<option value="1990">1990</option>
<option value="1991">1991</option>
<option value="1992">1992</option>
<option value="1993">1993</option>
<option value="1994">1994</option>
<option value="1995">1995</option>

<option value="1996">1996</option>
<option value="1996">1996</option>
<option value="1997">1997</option>
<option value="1998">1998</option>
<option value="1999">1999</option>
<option value="2000">2000</option>

<option value="2001">2001</option>
<option value="2002">2002</option>
<option value="2003">2003</option>
<option value="2004">2004</option>
<option value="2005">2005</option>
<option value="2006">2006</option>

<option value="2007">2007</option>
<option value="2008">2008</option>
<option value="2009">2009</option>
<option value="2010">2010</option>
<option value="2011">2011</option>
<option value="2012">2012</option>

<option value="2013">2013</option>
<option value="2014">2014</option>
<option value="2015">2015</option>
<option value="2016">2016</option>
<option value="2017">2017</option>
<option value="2018">2018</option>

<option value="2019">2019</option>
<option value="2020">2020</option>
</select>


</font></div>
<p><font face="Arial, Helvetica, sans-serif" size="-1">
</font>

<font size="4" face="Arial, Helvetica, sans-serif"
color="#FF0000">*</font><font face="Arial, Helvetica, sans-serif"
size="-1">Gender
: <input type="radio"
name="Male"
value="male" checked>
Male <INPUT type=radio value=female name=Male >
Female </font>








<hr>
<table border="0" cellpadding="0" cellspacing="0"
style="border-collapse: collapse" bordercolor="#111111" width="100%"
id="AutoNumber1" height="336">
<tr>
<td width="49%" height="336">
<div align="left">
<font size="4" face="Arial, Helvetica, sans-serif"
color="#FF0000"> </font><input type="radio" name="Student"
value="student"
onClick="generalclear(this.form)">Student </div>

<div align="left">
<font face="Arial, Helvetica, sans-serif" size="4"
color="#FF0000"> </font><img border="0"
src="Picture/star.GIF" width="13" height="17"><font size="-1"
face="Arial,
Helvetica, sans-serif">First
Name: </font><input type="text"
name="first_name_s"
size="28"> <font size="-1" face="Arial, Helvetica,
sans-serif"> </font></div>
<div align="left"> </div>
<div align="left"> <font face="Arial, Helvetica, sans-serif"
size="-1">
Middle Name: </font><input type="text" name="middle_name_s"
size="28"></div>

<div align="left"> </div>
<div align="left">
<font size="4" face="Arial, Helvetica, sans-serif"
color="#FF0000"> </font><img border="0"
src="Picture/star.GIF"
width="13" height="17"><font size="-1" face="Arial, Helvetica,
sans-serif">Last
Name: </font>
<input type="text" name="last_name_s" size="28"></div>
<p><font size="-1" face="Arial, Helvetica,
sans-serif"> </font><img border="0"
src="Picture/star.GIF" width="13" height="17"> Academic
Year:
<select size="1" name="year">

<option value="Year" selected>Year</option>
<option value="First">First</option>
<option value="Second">Second</option>
<option value="Third">Third</option>
<option value="Fourth">Fourth</option>
</select> </p>

<p> <img border="0"
src="Picture/star.GIF" width="13" height="16">
Year of Admission:15
<select size="1" name="adminyear">
<option value="adminyear" selected>Select Year</option>
<option value="1990">1990</option>
<option value="1991">1991</option>

<option value="1992">1992</option>
<option value="1993">1993</option>
<option value="1994">1994</option>
<option value="1995">1995</option>
<option value="1996">1996</option>
<option value="1996">1996</option>

<option value="1997">1997</option>
<option value="1998">1998</option>
<option value="1999">1999</option>
<option value="2000">2000</option>
<option value="2001">2001</option>
<option value="2002">2002</option>

<option value="2003">2003</option>
<option value="2004">2004</option>
<option value="2005">2005</option>
<option value="2006">2006</option>
<option value="2007">2007</option>
<option value="2008">2008</option>

<option value="2009">2009</option>
<option value="2010">2010</option>

</select></p>
<p> <font color="#FF0000"> </font>
<img border="0" src="Picture/star.GIF" width="13"
height="16">Department: <select size="1" name="dept">
<option selected value="dept">Select Department</option>

<option value="IT">Information Technology</option>
<option value="CSE">Computer Sc. & Engineering</option>
<option value="ECE">Electronics & Communication</option>
<option value="EE">Electrical Engineering</option>
<option value="ME">Mechanical Engineering</option>

<option value="CE">Civil Engineering</option>
</select></p>
<p>
<img border="0" src="Picture/star.GIF" width="13"
height="16">Roll: &nb
sp;
<input type="text" name="roll" size="7" >
<font color="#FF0033" size="2" face="Arial, Helvetica, sans-serif">
(Eg.2k1_612::Here 2k1 stands for year 2001:: 1,2,3,4,5,6 for dept
Civil,Elect,Mech,Comp,Ece and IT::Left digits indicates roll
no)</font></p>

<p><font face="Arial, Helvetica, sans-serif" size="2"
color="#FF0033">
</font><font size="-1" face="Arial, Helvetica, sans-serif">Hostel
No: <select size="1" name="hostelno">
<option selected value="selecthostel">Select Hostel</option>
<option value="Hoste1">Hostel 1</option>
<option value="Hostel2">Hostel 2</option>
<option value="Hostel3">Hostel 3</option>

<option value="Hostel4">Hostel 4</option>
<option value="LH">Ladies Hostel</option>
</select> </font></p>
<p><font face="Arial, Helvetica, sans-serif"
size="-1">
Room No :
<input type="text" name="roomno" size="10"> </font></p>

<p><font face="Arial, Helvetica, sans-serif"
size="-1">
Contact No:
<input type="text" size="8" name="std_s"
maxlength="6"><b> - </b>
<input type="text" size="9" name="phno_s"
maxlength="9"></font></p>
<p><font face="Arial, Helvetica, sans-serif"
size="-1">
Mobile No:
<input type="text" size="18" name="mobno_s"
maxlength="15">

</font> </p>
<p><font face="Arial, Helvetica, sans-serif"
size="-1">

Email:
<input type="text" name="email_s"
size="20">
</font> </p>
<p><font face="Arial, Helvetica, sans-serif"
size="-1">

</font> </p>

</td>
<td width="3%" height="336">
<img border="0" src="login_divide1.gif" width="23"
height="530"></td>
<td width="101%" height="336">
<input type="radio" name="Student" value="general"
onClick="studentclear(this.form)"> General
<div align="left"> <font size="-1" face="Arial, Helvetica,
sans-serif"> </font>
<font size="4" face="Arial, Helvetica, sans-serif"
color="#FF0000"> <img border="0" src="Picture/star1.GIF"
width="15"
height="16"></font><font size="-1" face="Arial, Helvetica,
sans-serif">First

Name: </font><input type="text" name="first_name"
size="28">
<font size="-1" face="Arial, Helvetica, sans-serif"> </font></div>
<div align="left"> </div>
<div align="left"> <font face="Arial, Helvetica, sans-serif"
size="-1"> </font>
<font size="4" face="Arial, Helvetica, sans-serif"
color="#FF0000">
<img border="0" src="Picture/star1.GIF" width="15"
height="15"></font><font face="Arial, Helvetica, sans-serif" size="-1">
Middle Name:</font><input type="text" name="middle_name"
size="28"></div>

<div align="left"> </div>
<div align="left">
<font size="4" face="Arial, Helvetica, sans-serif"
color="#FF0000"> </font><img border="0" src="Picture/star.GIF"
width="13" height="17"><font size="-1" face="Arial, Helvetica,
sans-serif">Last
Name: </font>
<input type="text" name="last_name" size="28"></div>
<p> <font size="-1" face="Arial,
Helvetica, sans-serif"> Select City: <select size="1"
name="city">
<option selected value="City">City</option>

<option value="BANGALORE">BANGALORE</option>
<option value="CHENNAI">CHENNAI</option>
<option value="DELHI">DELHI</option>
<option value="KOLKATA">KOLKATA</option>
<option value="MUMBAI">MUMBAI</option>
</select> </font></p>

<p><font face="Arial, Helvetica, sans-serif"
size="-1">
Other :
<input type="text" name="othercity" size="10"> </font><font
color="#FF0033" size="2" face="Arial, Helvetica, sans-serif">(If
other city please specify)</font><font face="Arial,
Helvetica, sans-serif" size="2"><b>
</b></font>
<font face="Arial, Helvetica, sans-serif" size="-1">
<br>
<br>
</font><img border="0"
src="Picture/star.GIF" width="13" height="17"><font face="Arial,
Helvetica, sans-serif" size="-1">Select

State:
<select size="1" name="state">
<option selected value="state">State</option>
<option value="ANDRA PRADESH">ANDRA PRADESH</option>
<option value="BIHAR">BIHAR</option>
<option value="DELHI">DELHI</option>

<option value="JAMMU & KASHMIR">JAMMU &
KASHMIR</option>
<option value="HARIYANA">HARIYANA</option>
<option value="KERAL">KERAL</option>
<option value="MADHYA PRADESH">MADHYA PRADESH</option>
<option value="MAHARASTA">MAHARASTA</option>

<option value="ORRISSA">ORRISSA</option>
<option value="RAJASTAN">RAJASTAN</option>
<option value="UTTAR PRADESH">UTTAR PRADESH</option>
<option value="WEST BENGAL">WEST BENGAL</option>
</select> </font>
</p>

<p> <font face="Arial, Helvetica, sans-serif"
size="-1">
</font>
<font size="4" face="Arial, Helvetica, sans-serif"
color="#FF0000"> </font><img border="0" src="Picture/star.GIF"
width="13" height="17"><font size="-1" face="Arial, Helvetica,
sans-serif">Select
a Country :<select size="1" name="country">
<option selected value="country">Country</option>
<option value="AFGANISTAN">AFGANISTAN</option>
<option value="BANGLADESH">BANGLADESH</option>

<option value="BARMA">BARMA</option>
<option value="BHUTAN">BHUTAN</option>
<option value="JAPAN">JAPAN</option>
<option value="INDIA">INDIA</option>
<option value="NEPAL">NEPAL</option>
<option value="PAKISTAN">PAKISTAN</option>

<option value="SRI LANKA">SRI LANKA</option>
</select>
<br>
<br>
</font>
<font size="4" face="Arial, Helvetica, sans-serif"
color="#FF0000"> </font><img border="0" src="Picture/star.GIF"
width="13" height="17"><font size="-1" face="Arial, Helvetica,
sans-serif">Zip
Code:

<select size="1" name="pincode">
<option selected value="pincode">Pincode</option>
<option value="700001">700001</option>
<option value="700002">700002</option>
<option value="700003">700003</option>
<option value="700004">700004</option>

<option value="700005">700005</option>
<option value="700006">700006</option>
<option value="700007">700007</option>
<option value="700008">700008</option>
<option value="700009">700009</option>
<option value="700010">700010</option>

<option value="700011">700011</option>
<option value="700012">700012</option>
<option value="700013">700013</option>
<option value="700014">700014</option>
<option value="700015">700015</option>
<option value="700016">700016</option>

<option value="700017">700017</option>
<option value="700017">700018</option>
<option value="700019">700019</option>
<option value="700020">700020</option>
<option value="700021">700021</option>
<option value="700022">700022</option>

<option value="700023">700023</option>
<option value="700024">700024</option>
<option value="700025">700025</option>
<option value="700026">700026</option>
<option value="700027">700027</option>
<option value="700028">700028</option>

<option value="700029">700029</option>
<option value="700030">700030</option>
<option value="700031">700031</option>
<option value="700032">700032</option>
<option value="700033">700033</option>
<option value="700034">700034</option>

<option value="700035">700035</option>
<option value="700036">700036</option>
<option value="700037">700037</option>
<option value="700038">700038</option>
<option value="700039">700039</option>
<option value="700040">700040</option>

</select> </font><p>
<font face="Arial, Helvetica, sans-serif"
size="-1">
Other:
<input type="text" name="otherpin" size="10"><font
color="#FF0033"> </font>
</font><font color="#FF0033" size="2" face="Arial, Helvetica,
sans-serif">(If
other Zip please specify)</font><font face="Arial,
Helvetica, sans-serif" size="2"><b>
</b></font>
<p> <font face="Arial, Helvetica, sans-serif"
size="-1">

Contact No: <input type="text" size="6" name="std"
maxlength="6"><b> -
</b> <input type="text" size="9" name="phno"
maxlength="9">
</font>
<p> <font face="Arial, Helvetica, sans-serif"
size="-1">
Mobile No: <input type="text" size="18"
name="mobno"
maxlength="15">
</font>
<p>

<font face="Arial, Helvetica, sans-serif"
size="-1">Email:
<input type="text" name="email"
size="20">
</font>
<p> </td>
</tr>
</table>
<hr>
<div align="left"><font face="Arial, Helvetica, sans-serif"
size="-1">

</font> </div>
<center>
<input type="submit" value="Submit" name="Submit"
tabindex="25">


<input type="reset" value="Reset" name="Reset" tabindex="26">
</center>
</form>
</table></body></html>

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