two email options ... two select location options ...
select location option using radio buttons...
<input type=radio name=storeemail value="
[email protected]"
/>
<input type=radio name=storeemail value="
[email protected]"
/>
<input type=radio name=storeemail value="
[email protected]"
/>
<input type=radio name=storeemail value="
[email protected]"
/>
select location using select
<select name=storeemail/>
<option value="
[email protected]"
/>
<option value="
[email protected]"
/>
<option value="
[email protected]"
/>
<option value="
[email protected]"
/>
</select>