--- /dev/null
+ <div>
+ <h1>Dialer</h1>
+
+ <form id="appform" method="post" name="appform">
+ <div id="city_div">
+ City: <input type="text" name="city"/>
+ </div>
+
+ <div id="state_div">
+ State: <input type="text" name="state"/>
+ </div>
+
+ <div id="company_div">
+ Company: <input type="text" name="company"/>
+ </div>
+
+ <div id="data_source_div">
+ Data Source: <input type="text" name="data_source"/>
+ </div><input type="submit" value="locate records"/>
+ </form>
+ </div>