<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<title>Form</title>
<style type="text/css">
*{margin:0;padding:0;}
fieldset, img{border:none;}
#wrap{width:465px;margin:15px;padding:15px;border:1px solid #ccc;background:#ebebeb;}
.row{clear:both;}
.field{float:left;margin-right:10px;}
.field input{width:140px;}
.clear{clear:both;}
#submit{width:150px;margin-top:20px;}
input:focus{background:#f9f2cf;}
</style>
</head>
<body>
<div id="wrap">
<form action="test.php">
<div class="row">
<div class="field">
Last Name:<br />
<input type="text" style="width:230px" />
</div>
<div class="field">
First Name:<br />
<input type="text" />
</div>
<div class="field">
Initials:<br />
<input type="text" style="width:50px;" />
</div>
</div>
<div class="row">
<div class="field">
Street Number and Name:<br />
<input type="text" style="width:448px"/>
</div>
</div>
<div class="row">
<div class="field">
City:<br />
<input type="text" style="width:230px;"/>
</div>
<div class="field">
State:<br />
<input type="text" style="width:50px;"/>
</div>
<div class="field">
Postal / Zip:<br />
<input type="text" />
</div>
</div>
<div class="row" style="width:460px;text-align:center;">
<input name="Submit" id="submit" type="button" value="Submit" />
</div>
</form>
<div class="clear"> </div>
</div>
</body>
</html>
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