<div>
	<h1>Dialer</h1>
	<form name="appform" id="appform" method="post">
		<div id="city_div">        City:        <input name="city" type="text"/> </div>
		<div id="state_div">       State:       <input value="catatonic" name="state" type="text"/> </div>
		<div id="company_div">     Company:     <input name="company" type="text"/> </div>
		<div id="data_source_div"> Data Source: <input name="data_source" type="text"/>	</div>
		<input value="locate records" type="submit"/>
	</form>
</div>