<form name="form1" method="post" action="http://www.XXXXX.com/mattfm.php" target="_top">
<INPUT TYPE="HIDDEN" NAME="redirect" VALUE="http://www.XXXXX.com/thankyounew.shtml">
<INPUT TYPE="HIDDEN" NAME="subject" VALUE="Contact message from your website">
<input type="hidden" name="required" value="name,email,address,city,state,zip">
<table width="438" border="0" cellpadding="0" cellspacing="0">
<tr>
<td width="101">Name:</td>
<td colspan="3"><input name="name" type="text">
<span class="required">*</span></td>
</tr>
<tr>
<td>Email:</td>
<td colspan="3"><input name="email" type="text">
<span class="required">*</span></td>
</tr>
<tr>
<td>Phone: </td>
<td colspan="3"><input name="phone" type="text">
</td>
</tr>
<tr>
<td>Address</td>
<td colspan="3"><input name="address" type="text" >
<span class="required">*</span></td>
</tr>
<tr>
<td>City, State, Zip</td>
<td width="144">
<div align="left">
<input name="city" type="text"size="20">
</div></td>
<td width="74"><input name="state" type="text"size="10">
</td>
<td width="99"><input name="zip" type="text"size="10">
<span class="required">*</span></td>