form.htmlp in Perl

<!-- $filename -->

<table>  <!-- for medicinal purposes -->

<tr> <td width=20 height=20>

<tr> <td width=20 height=20>
  <td width=300>

<form action="$callback" method=POST>

<p>Your Name:
<br><input type=text name=name value="$name" size=40>

<p>Your Email Address:
<br><input type=text name=email value="$email" size=40>

<p>The Subject of Your Message:
<br><input type=text name=subject value="$subject" size=40>

<p>Your Message:
<br>
<textarea cols=60 rows=10 name=message wrap=hard>$message</textarea>

<p>
<input type=submit value=" Send It ">
<input type=reset value="   Oops!   ">

<input type=hidden name=referer value="$referer">
<input type=hidden name=state value=send>

</form>

</table>