<form method="POST" action="--WEBBOT-SELF--">



</p>


MODULO RICHIESTA ASSITENZA/INFO</p>


A:
<select name="select" size="1">
<option value="1">luigi</option>
<option value="2">giada</option>
<option value="3">stefano</option>
<option value="4">sabrina</option>
</select>
</p>


TIPO RICHIESTA:
<select name="select2" size="1">
<option value="1">software</option>
<option value="2">gestionale</option>
</select>
</p>


OGGETTO:
<input name="textarea" type="text" value="">
</p>


DA:
<input type="text" name="textfield" />
(e-mail)</p>


SEGNALAZIONE</p>



<textarea name="textarea2" cols="36" rows="10"></textarea>
</p>


<input type="submit" value="Invia" name="B1"><input type="reset" value="Reimposta" name="B2"></p>
</form>