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<link rel="stylesheet" type="text/css" href="temp.css" />
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<button type="button">Home</button>
<button type="button">Provider</button>
<button type="button">Requester</button>
<button type="button">Contact Us</button>
<h3><p align="center"><b>Atlanta Services</b></p></h3>
<p align="left">You have indicated you need a service. Please complete
the form below and submit. We will search our database and display for you
possible providers. If no provider can be located at this time
we will keep your request until it expires or a provider contacts you by
phone.</p>
<p>Type of Service: <input type="text" name="Type of Service"
size="60"></p>
<p>Email: <input type="text" name="Email" size ="60"></p>
<p>Name: <input type="text" name="Name" size ="60"></p>
<p>Phone: <input type="text" name="Phone" size ="60"></p>
<p>Date: <input type="text" name="Date" size ="60"></p>
<p>Start Time: <input type="text" name="Start Time" size ="60"></p>
<p>End Time: <input type="text" name="End Time" size ="60"></p>
<p><input type=submit value="Submit"><input type=reset
value="Reset"></p>
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