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CODING HTML FORM

<br/><div style='text-align: left'><div><h4 style="text-decoration: blink;" align="center">DaftarPercuma Untuk Info Selanjutnya</h4><div><form name="form" method="post" action="http://www.vemmabuilder.com/819849905/pen"><table align="center" border="0" cellpadding="0" cellspacing="2"><tbody><tr><th width="33">&nbsp;</th><th width="154"><div align="center"><div align="left">NamaPertama</div></div></th><td width="3"><strong>:</strong></td><td width="170"><strong> <input name="surveyFirstName" value="" type="text"> </strong></td></tr><tr><th>&nbsp;</th><th><div align="center"><div align="left">NamaTerakhir</div></div></th><td><strong>:</strong></td><td><strong> <input name="surveyLastName" value="" type="text"> </strong></td></tr><tr><th>&nbsp;</th><th><div align="center"><div align="left">NoHP</div></div></th><td><strong>:</strong></td><td><strong> <input name="surveyPhone" value="" type="text"> </strong></td></tr><tr><th>&nbsp;</th><th><div align="center"><div align="left">Email</div></div></th><td><strong>:</strong></td><td><strong> <input name="surveyEmail" value="" type="text"> </strong></td></tr><tr><th>&nbsp;</th><th><div align="center"><div align="left">Email Sekali Lagi</div></div></th><td><strong>:</strong></td><td><strong> <input name="surveyConfirmEmail" value="" type="text"> </strong></td></tr><tr><th>&nbsp;</th><th><div align="center"><div align="left">Negara</div></div></th><td><strong>:</strong></td><td><strong><select name="surveyCountry"><option value="">Sila Pilih Negara</option><option value="1">United States</option><option value="12">Australia</option><option value="13">Austria</option><option value="36">Canada</option><option value="78">Germany</option><option value="99">Ireland</option><option value="103">Japan</option><option value="123">Indonesia</option><option value="123">Malaysia</option><option value="147">New Zealand</option><option value="163">Philippines</option><option value="183">Singapore</option><option value="184">Slovenia</option><option value="197">Taiwan</option><option value="213">United Kingdom</option></select></strong></td></tr><tr><th>&nbsp;</th><th><div align="center"><div align="left">SayaIngin Menjana</div></div></th><td><strong>:</strong></td><td><strong><select name="surveyIncomeGoal"><option value="">Sila Pilih </option><option value="0">Kurang Dari RM1000</option><option value="1">RM1000 sebulan</option><option value="2">RM3000 sebulan</option><option value="3">RM5000 sebulan</option><option value="4">lebih RM10000</option></select></strong></td></tr><tr><td colspan="4"><div align="center"><strong> <input onclick="javascript:mysize();scrollbar=1;exit=false" name="surveysubmit" value="SAYA MAHU SEPERTI ANDA" type="submit"></strong></div></td></tr><tr><td colspan="4"><div align="center">Selepas pendaftaran, kami akan email kepada anda langkah-langkah seterusnya dan juga beberapa fail untuk anda muat turun, kemudian terus mulakan kerja hanya dari rumah anda. </div></td></tr></tbody></table></form></div></div><div style='clear:both'></div>