>
Phone:
</span>
<input name="phone" style="position:absolute; width:405px; height:16px; left:141px; top:234px;" type="text">
<input value="Submit" style="position:absolute; width:60px; left:141px; top:344px;" onmouseup="formSubmit1(12)" type="button">
<select name="state" style="position:absolute; width:407px; height:21px; left:141px; top:178px;">
<option value="">-- please select --</option>
<option value="Alabama">Alabama</option>
<option value="Alaska">Alaska</option>
<option value="American Samoa">Amer