<form action="/samples/phonemsg.asp" method="post">
	<input type="hidden" name="action" value="send" />
	<table border="0" cellspacing="0" cellpadding="0"><tr><td>
	<table border="0" cellspacing="2" cellpadding="2">
		<tr>
			<td colspan="4" align="center">
				<font size="+2"><b>While You Were Out</b></font>
			</td>
		</tr>
		<tr>
			<td align="right">Message For:</td>
			<td colspan="3">
				<input type="text" name="to" value="Enter Email" size="30" />
				<!--
				<select name="to" />
				<option value="Fred Doe <noone@asp101.com>">Fred Doe <noone@asp101.com></option>
<option value="John Doe <noone@asp101.com>">John Doe <noone@asp101.com></option>
<option value="Jane Doe <noone@asp101.com>">Jane Doe <noone@asp101.com></option>
<option value="Nancy Doe <noone@asp101.com>">Nancy Doe <noone@asp101.com></option>
				</select>
				-->
			</td>
		</tr>
		<tr>
			<td align="right">Taken By:</td>
			<td colspan="3">
				<select name="takenby" />
				<option value="Fred Doe <noone@asp101.com>">Fred Doe <noone@asp101.com></option>
<option value="John Doe <noone@asp101.com>">John Doe <noone@asp101.com></option>
<option value="Jane Doe <noone@asp101.com>">Jane Doe <noone@asp101.com></option>
<option value="Nancy Doe <noone@asp101.com>">Nancy Doe <noone@asp101.com></option>
				</select>
			</td>
		</tr>
		<tr>
			<td align="right">Date:</td>
			<td><input type="text" name="date" value="1/9/2001" size="10" /></td>
			<td align="right">Time:</td>
			<td><input type="text" name="time" value="5:38:16 PM" size="10" /></td>
			</td>
		</tr>
		<tr>
			<td align="right">
				<select name="mrs">
					<option>Mr.</option>
					<option>Mrs.</option>
					<option>Ms.</option>
				</select>
			</td>
			<td colspan="3"><input type="text" name="caller" size="30" /></td>
		</tr>
		<tr>
			<td align="right">Company:</td>
			<td colspan="3"><input type="text" name="company" size="30" /></td>
		</tr>
		<tr>
			<td align="right">Phone:</td>
			<td colspan="3"><input type="text" name="phone" size="30" /></td>
		</tr>
		<tr>
			<td>
			</td>
			<td colspan="3">
				<table border="0" cellspacing="1" cellpadding="0">
				<tr>
					<td><input type="checkbox" name="notes" value="Returned Call" />Returned Call</input></td>
					<td><input type="checkbox" name="notes" value="Please Call" />Please Call</input></td>
				</tr>
				<tr>
					<td><input type="checkbox" name="notes" value="Will Call Again" />Will Call Again</input></td>
					<td><input type="checkbox" name="notes" value="Urgent" />Urgent</input></td>
				</tr>
				</table>
			</td>
		</tr>
	</table>
	<table border="0" cellspacing="2" cellpadding="2">
		<tr>
			<td colspan="4">
				Message:<br />
				<textarea name="message" cols="40" rows="10" wrap="virtual"></textarea>
			</td>
		</tr>
		<tr>
			<td colspan="4" align="right">
				<input type="submit" value="Send Message" />
			</td>
		</tr>
	</table>
	</td></tr></table>
	</form>