<?xml version="1.0" encoding="UTF-8"?>

<form url="newsletter.php"
 window="_self"
 method="POST"
 fontname="MS Sans Serif"
 width="155"
 height="95"
 bkcolor="0xE0DAC7"
 transparent="f"
 fontcolor="0x000000"
 outlinecolor="0xE0DAC7"
 themecolor="0xFFFF99"
 fontcolor2="#000000"
 bkcolor2="#FFFFFF"
 includeresults="false"
 emailuser="false"
 bcc=""
 cc=""
 reqmessage="One or More Fields are Required"
 transition="0"
 autoresponseincluderesults="f"
 autoresponseaddtotop="f"
 usephp="true"
 disableclicktoactiveprompt="true"
 extensions="*.txt;*.gif;*.jpg;*.jpeg;*.zip;*.doc;*.png;*.pdf;*.rtf"
>

<hidden
 name="subject"
 value="AH Web - Newsletter Request"
></hidden>

<textinput
 name="E-mail Address"
 x="4"
 y="4"
 w="149"
 h="22"
 initvalue="Enter E-mail Address"
 bkcolor="0xFFFFFF"
  fontname="Arial"
  fontcolor="0x000000"
 emailbox="true"
  restrict="email"
>
</textinput>

<checkbox
 name="My Check Box 1"
 x="4"
 y="32"
 w="72"
 h="19"
 label="Subscribe"
 labelPos="right"
 value="checked"
 checked="true"
  fontsize="12"
  fontname="Arial"
  fontcolor="0x000000"
></checkbox>

<checkbox
 name="My Check Box 2"
 x="4"
 y="52"
 w="87"
 h="19"
 label="Unsubscribe"
 labelPos="right"
 value="checked"
  fontsize="12"
  fontname="Arial"
  fontcolor="0x000000"
></checkbox>

<submitbutton
 name="Submit Button"
 x="4"
 y="72"
 w="100"
 h="20"
 label="Submit"
 fontname="Arial"
 fontcolor="0x000000"
  fontsize="12"
></submitbutton>

</form>