4 <form id="appform" method="post" name="appform">
6 City: <input type="text" name="city"/>
10 State: <input type="text" name="state"/>
13 <div id="company_div">
14 Company: <input type="text" name="company"/>
17 <div id="data_source_div">
18 Data Source: <input type="text" name="data_source"/>
19 </div><input type="submit" value="locate records"/>