<form action="http://www.starbuzzcoffee.com/processorder.php" method="POST">
  <p><label>Choose your beans: <select name="beans">
    <option value="House Blend">House Blend</option>
    <option value="Bolivia">Shade Grown Bolivia Supremo</option>
    <option value="Guatemala">Organic Guatemala</option>
    <option value="Kenya">Kenya</option>
  </label></p>
  <p><label>Type: <br />
    <label><input type="radio" name="beantype" value="whole" /> Whole bean</label>
    <br />
    <label><input type="radio" name="beantype" value="ground" checked /> Ground</label>
  </p>
  <p>Extras: <br />
    <label><input type="checkbox" name="extras[]" value="giftwrap" /> Gift wrap</label>
    <br />
    <label><input type="checkbox" name="extras[]" value="catalog" checked /> Include
        catalog with order</label>
  </p>
  <p>Ship to: <br />
    <label>Name: <input type="text" name="name" /></label><br />
    <label>Address: <input type="text" name="address" /></label><br />
    <label>City: <input type="text" name="city" /></label><br />
    <label>State: <input type="text" name="state" /></label><br />
    <label>Zip: <input type="text" name="zip" /></label><br />
  </p>
  <p>Customer Comments: <br />
    <textarea name="comments" rows="10" cols="48"></textarea>
  </p>
  <p>
    <input type="submit" value="Order Now" />
  </p>
</form>