Page 129 - Plus_V2.2_C8_Flipbook
P. 129

<P>
                       <LABEL>Enter your Last name</LABEL><BR>
                       <INPUT TYPE="TEXT" NAME="LAST_NAME">
                    </P>
                     <P>
                       <LABEL>Email</LABEL><BR>

                       <INPUT TYPE="EMAIL" NAME="EMAIL" REQUIRED>
                     </P>
                    <P>
                      <LABEL>Mobile number</LABEL><BR>
                       <INPUT TYPE="TEL" NAME="PHONE">
                    </P>
                     <P>

                       <LABEL>Password</LABEL><BR>
                       <INPUT TYPE="PASSWORD" NAME="PASSWORD">
                     </P>
                     <P>
                       <LABEL>Zone</LABEL><BR>
                       <SELECT>

                        <OPTION>East</OPTION>
                        <OPTION>West</OPTION>
                         <OPTION>South</OPTION>
                         <OPTION>North</OPTION>
                       </SELECT>
                     </P>
                     <P>

                       <LABEL>
                         <INPUT TYPE="CHECKBOX" VALUE="TERMS">
                         I agree to the <a href=terms.HTML>terms and conditions</A>
                       </LABEL>
                     </P>
                    <P>

                       <INPUT TYPE=SUBMIT VALUE=SUBMIT>
                       <BR><BR>
                      <INPUT TYPE=RESET VALUE=RESET>
                       </P>
                   </FORM>
                   </BODY>
                   </HTML>



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