HTML Help

I edited another html to come up with this form.  I want the user (everyone on the internet) to be able to fill out the form and the data go into our system.   


<script>
$(function()
{
$("#email").change(
function(e){
$("#email").val($(e.target).val());
}
);
}

);
</script>


<h1 style="text-align: center;"><br></h1>
<p></p>

<meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
<title>Contribution Submission Tracker</title>
<style type="text/css">
body{
font-family:Verdana, Arial, Helvetica, sans-serif;
font-size:11px;
}
input{margin-left:10px; padding:5;}
select{border:0; margin-left:10px; padding:5;}
p, h1, form, button{border:0; margin:0; padding:0;}
.spacer{clear:both; height:1px;}

/* ----------- Add Submission Form ----------- */
.addrequestform{
margin:0 auto;
width:500px;
padding:14px;
}
#stylized{
border:solid 2px #b7ddf2;
background:#EEEEEE;
}
#stylized h1 {
font-size:12px;
font-weight:bold;
margin-bottom:8px;
}
#stylized p{
font-size:11px;
color:#666666;
margin-bottom:20px;
border-bottom:solid 1px #b7ddf2;
padding-bottom:10px;
}
#stylized label{
display:block;
font-weight:bold;
text-align:right;
width:150px;
float:left;
}
#stylized .small{
color:#666666;
display:block;
font-size:11px;
font-weight:normal;
text-align:right;
width:150px;
}
#stylized input.radio{
float:left;
font-size:11px;
padding:4px 2px;

}
#stylized .texta, textarea{
border:solid 1px #aacfe4;
width:300px;
float:left;
font-size:11px;
padding:4px 2px;
margin:2px 0 20px 10px;

}

</style>



<div id="stylized" class="addrequestform">
<form name="enForm" method="POST" action="bcyiggmeq?act=API_AddRecord&amp;apptoken=dzs5cvbibe7ubcb6yk4gdfvixub">
<input type="hidden" name="rdr" value="/db/bcyiggmeq?a=dbpage&amp;pagename=thankyou.html">

<h1>Plant Submission</h1>

<p>Please enter your submission below. A copy will be emailed to the email address provided.</p>

<label>Name:
<span class="small">Enter your name</span></label>
<input type="text" name="_fid_12" class="texta">
<div class="spacer"></div>

<label>Email:
<span class="small">Enter your Arcosa email address</span></label>
<input type="text" name="_fid_142" id="email" class="texta">
<div class="spacer"></div>

<label>Plant:

<span class="small">Select your plant</span></label>
<select name="_fid_132">
<option value="1881 - Ark City">1881 - Ark City</option>
<option value="1606 - Diamond Pro Plant">1606 - Diamond Pro Plant</option>
<option value="1676 - Curry">1676 - Curry</option>
</select>
<div class="spacer"></div>


<h1>Contribution Information</h1>

<label>Volunteer Hours:
<span class="small">Enter the hours spent volunteering</span></label>
<input type="text" name="_fid_138" class="texta">
<div class="spacer"></div>

<label>Dollars Contributed:
<span class="small">Enter the dollars contributed</span></label>
<input type="text" name="_fid_141" class="texta">
<div class="spacer"></div>



<label>Comment:
<span class="small">Enter your comment</span></label>
<input type="text" name="_fid_140" class="texta">
<div class="spacer"></div>

<label>Contribution Category:
<span class="small"></span></label>
<select name="_fid_139">
<option value="1Education">Education</option>
<option value="Atheletics">1Atheletics</option>
<div class="spacer"></div>





<input onclick="submit" type="submit" value="Submit">


</form>
</div>

------------------------------
Sarah Burres
------------------------------