The red tags are required fields for the ordertype "Bemail Renewal".

<center>
<img align=center src="demobanr.jpg" alt="Demonstration Illustrated" height=60 width=160>
<br>
Welcome to Demonstration Illustrated Renewal Center </font></b>
</center>
</p>
<HR>
<p>
<font color=black><b>
<FORM action="www.neodata.com/ITPS2.cgi" method=post>
<input type=hidden name="ItemCode" value="demo">
<input type=hidden name="SourceCode" value="1">
<input type=hidden name="KeyCode" value="DMO">
<input type=hidden name="OrderType" value="bemail renewal">
<input type=hidden name="Matchcode" value="The17DigitCustomerId">
<input type=hidden name="Country" value="USA">
<input type=hidden name="PubName" value="Demonstration Illustrated">
<p>
Please renew my subscription for: <p>
<b><input type=radio name="Term" value="22@29.97" checked>
22 issues (1 year) for only $29.97</b> (<i>save 66%</i>)<br>
<b><input type=radio name="Term" value="44@54.97">
44 issues (2 years) for only $54.97</b> (<i>save 68%</i>)
<table border=0>
<tr>
<td><b><font color=black>Name:</font></b></td>
<td><input type="text" name="FullName" SIZE="24" value="Jane W. Skof"><br></td>
</tr>
<tr>
<td><b><font color=black>Street Address:</font></b></td>
<td><input type="text" name="StreetAdr" size="24" value="123 Main St"><br></td>
</tr>
<tr>
<td><b><font color=black>Add'l Address Info:</font></b></td>
<td><input type="text" name="SuppAdr" SIZE="24" value="Apt 101"><br></td>
</tr>
<tr>
<td><b><font color=black>City: </td>
<td><input type="text" name="City" size="18" value="Boulder">
<b><font color=black> State:
<input type="text" name="State" size="2" value="CO">
Zip:</font></b>
<input type="text" name="PostalCode" size="6" value="80303"><br></td>
</tr>
<tr>
<td><b><font color=black>Email Address:</font></b> <br></td>
<td><input type="text" name="EmailAdr" SIZE="40" value="jw@skof.com"><br></td>
</tr>
<tr>
<td colspan=2 align=center>
<input type=radio name="CcType" Value="Bill Me" checked><b> <font color=black>Bill me
<input type=radio name="CcType" Value="Visa"> Visa
<input type=radio name="CcType" Value="Mastercard"> Mastercard
<input type=radio name="CcType" Value="Amex"> Amex</font></b><br></td>
</tr>
<tr>
<td><b><font color=black>Credit Card #:</font></b></td>
<td><input type="text" name="CcNumber" size="16"><br></td>
</tr>
<tr>
<td><b><font color=black>Expiration Date:</font></b></td>
<td><input type="text" name="CcExpire" size="4"><br></td>
</tr>
</table>
<p>
<input type="hidden" name="iReturnURL" value="http://your_domain@your_server/Your_Web_Page/">
<input type="hidden" name="iReturnURLText" value="Your_Hyperlink_Text">
<input type="hidden" name="RequiredFields" value="Your_Required_Field@Your_Error_Message.">
<img src="order1.gif"></a>
</form>