Tell us about yourself, please.

The idea behind this form is to help us demonstrate our php programming abilities, to you, whilst creating a permanent record of your fruit and vegetable preferences..

If you fill in your e-mail address, a php program will send you an automated e-mail message, to that address, from Leafy Green, proprietor of Leafy Green Web Publishing, reminding you what information you entered into the form below, and briefly remarking about it. You will receive a list of variable names, and values. If you do not include an email address, we will get any information that you included, but we will not get your address. To have the automated email sent to you, only your e-mail address is required; all the other information on the form below is optional. If you want a personal response, we can do that too. Just say so in the "How Can we Help You?" box. We will read it and respond. If for some reason you don't get a "thank you" page after pressing the submit button, it means the form has probably not been successfully submitted to your, or us.

Privacy clause: we will be keeping a record of the information you provide: the php program that sends you an automated e-mail message, also sends a copy of your responses, by e-mail, to Leafy Green Web Services. It will be stored in our database file of people and their fruit and vegetables preferences. Furthermore, any information you provide about your favorite fruits and vegetables may be disclosed to anyone and everyone. So think twice before you give us this kind of personal information! If you don't want everyone to know how much you love persimmons or beets, don't tell us! However we will not give your e-mail address to anyone, so no-one but us will be able to contact you, and unless you ask us to, we will not contact you either, beyond sending you the automated e-mail message, we mentioned.

Name:
Address:
City:
State:
Zip Code:
Country:
Email address:
Pick one vegetable:
brocolli cauliflower
asparagas beets
green beans turnips

Check off all the fruits you like:
Apples persimmons
Oranges   grapefruit
Grapes rasberries

When I grow up I want to be (a)(an):
 
How can we help you?