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Title User registration Form using Java Script.
Author Sukanta Mondal
Author Email suku_jgec_it [at] yahoo.com
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.
Category » Forms
Hits 18609
Code Select and Copy the Code
<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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