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<html>
<head>
<title>TEST</title>
</head>
<body bgcolor="white">
<h3>TEST</h3>
<form action="TEST" method="get">
<div>
<input id="_submitted" name="_submitted" type="hidden" value="1" />
<input id="_sessionid" name="_sessionid" type="hidden" value="H8N0TAC5" />
<table>
<tr valign="top">
<td>Acct #:</td>
<td><input id="acct" name="acct:" true="false" type="text" /></td>
</tr>
<tr valign="top">
<td>Phone </td>
<td><table>
<tr>
<td><input id="phone" name="phone()" type="checkbox" value="1" /></td>
<td><label for="phone">1</label></td>
</tr>
</table></td>
</tr>
<tr valign="top">
<td>Taco</td>
<td><input id="taco_punch" name="taco.punch" type="text" /></td>
</tr>
<tr valign="top">
<td>Salad </td>
<td><input id="salad" name="salad$" type="text" /></td>
</tr>
<tr valign="top">
<td align="center" colspan="2"><input id="_submit" name="_submit" type="submit" value="Submit" /></td>
</tr>
</table>
</div>
</form>
</body>
</html>
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