3 <form name="appform" id="appform" method="post">
4 <div id="city_div"> City:
5 <input name="city" type="text"/>
7 <div id="state_div"> State:
8 <input value="catatonic" name="state" type="text"/>
10 <div id="company_div"> Company:
11 <input name="company" type="text"/>
13 <div id="data_source_div"> Data Source:
14 <input name="data_source" type="text"/>
16 <input value="locate records" type="submit"/>