<HTML><BODY>
<FORM ACTION="http://www.YourDomain.com/cgi-bin/cgiemail/mail.txt" METHOD="POST">
<INPUT TYPE="HIDDEN" NAME="success" VALUE="http://www.YourDomain.com/order_response.html">
Name: <INPUT TYPE="TEXT" NAME="name">
Product: <INPUT TYPE="TEXT" NAME="product">
Email: <INPUT TYPE="TEXT" NAME="email">
<INPUT TYPE="SUBMIT" VALUE="Send Form">
</FORM>
</BODY></HTML>