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1 <!DOCTYPE HTML> 2 <html> 3 <head> 4 <title>Order Form</title> 5 </head> 6 <body> 7 <form action="database.php" method="POST" enctype="multipart/form-data"> 8 <table> 9 <tr> 10 <td>Customer Name: </td> 11 <td><input type = "text" id ="Name" name="Name"></td> 12 </tr> 13 <tr> 14 <td>Phone Number: </td> 15 <td><input type="text" id ="Phone" name="Phone"></td> 16 </tr> 17 <tr> 18 <td>Order Date: </td> 19 <td><input type="Date" id ="OrderDate" name="OrderDate"></td> 20 </tr> 21 <tr> 22 <td>Shipping Date: </td> 23 <td><input type="Date" id ="ShipDate" name="ShipDate"></td> 24 </tr> 25 </table> 26 <label for="Comments">Comments:</label> 27 <textarea id="Comments" name="Comments" rows="4" cols="50"> 28 </textarea><br> 29 <label for="email">Enter your email:</label> 30 <input type="email" id="email" name="email"><br> 31 <input type="checkbox" id="Food[]" name="Food[]" value="Brownie"> 32 <label for="ChocolateFudgeBrownie"> Chocolate Fudge Brownie</label><br> 33 <input type="checkbox" id="Food[]" name="Food[]" value="PoundCake"> 34 <label for="PoundCake"> Pound Cake</label><br> 35 <input type="checkbox" id="Food[]" name="Food[]" value="Madeline"> 36 <label for="Madeline"> Madeline Cookies</label><br> 37 <input type="checkbox" id="Food[]" name="Food[]" value="ChocoLava"> 38 <label for="ChocoLava"> Chocolate Lava Cake</label><br> 39 <input type="checkbox" id="Food[]" name="Food[]" value="ChocoChip"> 40 <label for="ChocoChip"> Chocolate Chip Cookies</label><br> 41 <input type="submit" value="Submit"> 42 <input type="reset"> 43 </form> 44 </body>