Hi.. I’m trying to customize my signup form to look like this
<!-- login form section-->
<fieldset>
<legend>Username</legend>
<div>
</div>
<div>
In order to become a member of Endless-Bleach you must first select a username.
This will be your unique identification that people will know you as on all
of our website features. Please make sure you pick the one you want as you
can not change it later.</div>
<div>
<label for="username"><strong>Username*</strong></label><br>
<input type="text" name="username" class="inputBox" style="width:120px" size="20" maxlength="15" value="[+username+]"></div>
</fieldset>
<div>
</div>
<fieldset>
<legend>Password</legend>
<div>
</div>
<div>
Please enter a password you wish to use to login to your account. Passwords
must be between 3 and 16 characters and are cAsE sEnSiTiVe.</div>
<div>
<label for="password"><strong>Password*</strong></label><br>
<input type="password" name="password" class="inputBox" style="width:200px" size="20"></div>
<div>
<label for="confirm_password"><strong>Confirm Password*</strong></label><br>
<input type="password" name="confirmpassword" class="inputBox" style="width:200px" size="20"></div>
</fieldset>
<div>
</div>
<fieldset>
<legend>Email Address</legend>
<div>
</div>
<div>
To become a member of Endless-Bleach we require a valid e-mail address. This is
so we can contact you if necessary. Endless-Bleach will never share your e-mail
address with other groups, and if selected your e-mail address will be kept
private to all members except for Administrators. Note that you will only be
able to register once per e-mail address.</div>
<div>
<label for="email_address"><strong>Email Address*</strong></label><br>
<input type="text" name="email" class="inputBox" style="width:200px" size="20" value="[+email+]"></div>
<div>
<br> </div>
</fieldset>
<div>
</div>
<fieldset>
<legend>Full Name</legend>
<div>
</div>
<div>
Tell us your full name. This field is not required to sign up.</div>
<div>
<label for="month"><strong>Full Name</strong></label><label for="referrer">
<em style="color: rgb(204, 204, 204);">Optional</em></label><br>
<input type="text" name="fullname" class="inputBox" style="width:200px" size="20" maxlength="100" value="[+fullname+]"></div>
</fieldset>
<div>
</div>
<fieldset>
<legend>Country / State / Zip</legend>
<div>
</div>
<div>
Please select the country from where you are signing up on. And also provide
us with the state and zip code.</div>
<div>
<label for="referrer"><strong>Country</strong>
<em style="color: rgb(204, 204, 204);">Optional</em></label><br>
<select size="1" name="country" style="width:200px">
<option value="" selected> </option>
<option value="1">Afghanistan</option>
<option value="2">Albania</option>
<option value="3">Algeria</option>
<option value="4">American Samoa</option>
<option value="5">Andorra</option>
<option value="6">Angola</option>
<option value="7">Anguilla</option>
<option value="8">Antarctica</option>
<option value="9">Antigua and Barbuda</option>
<option value="10">Argentina</option>
<option value="11">Armenia</option>
<option value="12">Aruba</option>
<option value="13">Australia</option>
<option value="14">Austria</option>
<option value="15">Azerbaijan</option>
<option value="16">Bahamas</option>
<option value="17">Bahrain</option>
<option value="18">Bangladesh</option>
<option value="19">Barbados</option>
<option value="20">Belarus</option>
<option value="21">Belgium</option>
<option value="22">Belize</option>
<option value="23">Benin</option>
<option value="24">Bermuda</option>
<option value="25">Bhutan</option>
<option value="26">Bolivia</option>
<option value="27">Bosnia and Herzegowina</option>
<option value="28">Botswana</option>
<option value="29">Bouvet Island</option>
<option value="30">Brazil</option>
<option value="31">British Indian Ocean Territory</option>
<option value="32">Brunei Darussalam</option>
<option value="33">Bulgaria</option>
<option value="34">Burkina Faso</option>
<option value="35">Burundi</option>
<option value="36">Cambodia</option>
<option value="37">Cameroon</option>
<option value="38">Canada</option>
<option value="39">Cape Verde</option>
<option value="40">Cayman Islands</option>
<option value="41">Central African Republic</option>
<option value="42">Chad</option>
<option value="43">Chile</option>
<option value="44">China</option>
<option value="45">Christmas Island</option>
<option value="46">Cocos (Keeling) Islands</option>
<option value="47">Colombia</option>
<option value="48">Comoros</option>
<option value="49">Congo</option>
<option value="50">Cook Islands</option>
<option value="51">Costa Rica</option>
<option value="52">Cote D'Ivoire</option>
<option value="53">Croatia</option>
<option value="54">Cuba</option>
<option value="55">Cyprus</option>
<option value="56">Czech Republic</option>
<option value="57">Denmark</option>
<option value="58">Djibouti</option>
<option value="59">Dominica</option>
<option value="60">Dominican Republic</option>
<option value="61">East Timor</option>
<option value="62">Ecuador</option>
<option value="63">Egypt</option>
<option value="64">El Salvador</option>
<option value="65">Equatorial Guinea</option>
<option value="66">Eritrea</option>
<option value="67">Estonia</option>
<option value="68">Ethiopia</option>
<option value="69">Falkland Islands (Malvinas)</option>
<option value="70">Faroe Islands</option>
<option value="71">Fiji</option>
<option value="72">Finland</option>
<option value="73">France</option>
<option value="74">France, Metropolitan</option>
<option value="75">French Guiana</option>
<option value="76">French Polynesia</option>
<option value="77">French Southern Territories</option>
<option value="78">Gabon</option>
<option value="79">Gambia</option>
<option value="80">Georgia</option>
<option value="81">Germany</option>
<option value="82">Ghana</option>
<option value="83">Gibraltar</option>
<option value="84">Greece</option>
<option value="85">Greenland</option>
<option value="86">Grenada</option>
<option value="87">Guadeloupe</option>
<option value="88">Guam</option>
<option value="89">Guatemala</option>
<option value="90">Guinea</option>
<option value="91">Guinea-bissau</option>
<option value="92">Guyana</option>
<option value="93">Haiti</option>
<option value="94">Heard and Mc Donald Islands</option>
<option value="95">Honduras</option>
<option value="96">Hong Kong</option>
<option value="97">Hungary</option>
<option value="98">Iceland</option>
<option value="99">India</option>
<option value="100">Indonesia</option>
<option value="101">Iran (Islamic Republic of)</option>
<option value="102">Iraq</option>
<option value="103">Ireland</option>
<option value="104">Israel</option>
<option value="105">Italy</option>
<option value="106">Jamaica</option>
<option value="107">Japan</option>
<option value="108">Jordan</option>
<option value="109">Kazakhstan</option>
<option value="110">Kenya</option>
<option value="111">Kiribati</option>
<option value="112">Korea, Democratic People's Republic of</option>
<option value="113">Korea, Republic of</option>
<option value="114">Kuwait</option>
<option value="115">Kyrgyzstan</option>
<option value="116">Lao People's Democratic Republic</option>
<option value="117">Latvia</option>
<option value="118">Lebanon</option>
<option value="119">Lesotho</option>
<option value="120">Liberia</option>
<option value="121">Libyan Arab Jamahiriya</option>
<option value="122">Liechtenstein</option>
<option value="123">Lithuania</option>
<option value="124">Luxembourg</option>
<option value="125">Macau</option>
<option value="126">Macedonia, The Former Yugoslav Republic of</option>
<option value="127">Madagascar</option>
<option value="128">Malawi</option>
<option value="129">Malaysia</option>
<option value="130">Maldives</option>
<option value="131">Mali</option>
<option value="132">Malta</option>
<option value="133">Marshall Islands</option>
<option value="134">Martinique</option>
<option value="135">Mauritania</option>
<option value="136">Mauritius</option>
<option value="137">Mayotte</option>
<option value="138">Mexico</option>
<option value="139">Micronesia, Federated States of</option>
<option value="140">Moldova, Republic of</option>
<option value="141">Monaco</option>
<option value="142">Mongolia</option>
<option value="143">Montserrat</option>
<option value="144">Morocco</option>
<option value="145">Mozambique</option>
<option value="146">Myanmar</option>
<option value="147">Namibia</option>
<option value="148">Nauru</option>
<option value="149">Nepal</option>
<option value="150">Netherlands</option>
<option value="151">Netherlands Antilles</option>
<option value="152">New Caledonia</option>
<option value="153">New Zealand</option>
<option value="154">Nicaragua</option>
<option value="155">Niger</option>
<option value="156">Nigeria</option>
<option value="157">Niue</option>
<option value="158">Norfolk Island</option>
<option value="159">Northern Mariana Islands</option>
<option value="160">Norway</option>
<option value="161">Oman</option>
<option value="162">Pakistan</option>
<option value="163">Palau</option>
<option value="164">Panama</option>
<option value="165">Papua New Guinea</option>
<option value="166">Paraguay</option>
<option value="167">Peru</option>
<option value="168">Philippines</option>
<option value="169">Pitcairn</option>
<option value="170">Poland</option>
<option value="171">Portugal</option>
<option value="172">Puerto Rico</option>
<option value="173">Qatar</option>
<option value="174">Reunion</option>
<option value="175">Romania</option>
<option value="176">Russian Federation</option>
<option value="177">Rwanda</option>
<option value="178">Saint Kitts and Nevis</option>
<option value="179">Saint Lucia</option>
<option value="180">Saint Vincent and the Grenadines</option>
<option value="181">Samoa</option>
<option value="182">San Marino</option>
<option value="183">Sao Tome and Principe</option>
<option value="184">Saudi Arabia</option>
<option value="185">Senegal</option>
<option value="186">Seychelles</option>
<option value="187">Sierra Leone</option>
<option value="188">Singapore</option>
<option value="189">Slovakia (Slovak Republic)</option>
<option value="190">Slovenia</option>
<option value="191">Solomon Islands</option>
<option value="192">Somalia</option>
<option value="193">South Africa</option>
<option value="194">South Georgia and the South Sandwich Islands</option>
<option value="195">Spain</option>
<option value="196">Sri Lanka</option>
<option value="197">St. Helena</option>
<option value="198">St. Pierre and Miquelon</option>
<option value="199">Sudan</option>
<option value="200">Suriname</option>
<option value="201">Svalbard and Jan Mayen Islands</option>
<option value="202">Swaziland</option>
<option value="203">Sweden</option>
<option value="204">Switzerland</option>
<option value="205">Syrian Arab Republic</option>
<option value="206">Taiwan</option>
<option value="207">Tajikistan</option>
<option value="208">Tanzania, United Republic of</option>
<option value="209">Thailand</option>
<option value="210">Togo</option>
<option value="211">Tokelau</option>
<option value="212">Tonga</option>
<option value="213">Trinidad and Tobago</option>
<option value="214">Tunisia</option>
<option value="215">Turkey</option>
<option value="216">Turkmenistan</option>
<option value="217">Turks and Caicos Islands</option>
<option value="218">Tuvalu</option>
<option value="219">Uganda</option>
<option value="220">Ukraine</option>
<option value="221">United Arab Emirates</option>
<option value="222">United Kingdom</option>
<option value="223">United States</option>
<option value="224">United States Minor Outlying Islands</option>
<option value="225">Uruguay</option>
<option value="226">Uzbekistan</option>
<option value="227">Vanuatu</option>
<option value="228">Vatican City State (Holy See)</option>
<option value="229">Venezuela</option>
<option value="230">Viet Nam</option>
<option value="231">Virgin Islands (British)</option>
<option value="232">Virgin Islands (U.S.)</option>
<option value="233">Wallis and Futuna Islands</option>
<option value="234">Western Sahara</option>
<option value="235">Yemen</option>
<option value="236">Yugoslavia</option>
<option value="237">Zaire</option>
<option value="238">Zambia</option>
<option value="239">Zimbabwe</option>
</select></div>
<div>
<label for="confirm_password"><strong>State</strong></label><label for="referrer">
<em style="color: rgb(204, 204, 204);">Optional</em></label><br>
<input type="text" name="state" class="inputBox" style="width:200px" size="20" maxlength="50" value="[+state+]"></div>
<div>
<label for="confirm_password"><strong>Zip</strong></label><label for="referrer">
<em style="color: rgb(204, 204, 204);">Optional</em></label><br>
<input type="text" name="zip" class="inputBox" style="width:200px" maxlength="50" size="20" value="[+zip+]"></div>
</fieldset>
But There is something wrong with it. I replaced the original form in the "websignup.inc.php" with that one above but the thing is It wont submit or something is wrong not sure what.. If anyone can help me out in how I can do this?