John-Marc, please forgive my ignorance this week - I'm quitting smoking and genuinely believe I am getting way too much oxygen for my brain to handle!

Here's the sample template (written in html):

HTML Code:
<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1" />
<title>Untitled Document</title>
</head>
<body>
<form action="formprocessor2.php" method="POST"><table width="100%" border="0" cellspacing="10" cellpadding="0">
  <tr>
    <td>Customer Input Section - all info is optional </td>
    <td width="50%">Design Preview </td>
  </tr>
  <tr>
    <td width="50%"><table width="202%" border="0" cellspacing="10" cellpadding="0">
  <tr>
    <td>Background Selection </td>
    <td><label>
      <input name="radiobutton" type="radio" value="radiobutton" tabindex="1"/>
      Blue Image 
      <input name="radiobutton" type="radio" value="radiobutton" tabindex="2" />
      Red Image<br />
      <input name="radiobutton" type="radio" value="radiobutton" tabindex="3" />
      Purple Image 
      <input name="radiobutton" type="radio" value="radiobutton" tabindex="4" />
      No Image</label></td>
  </tr>
  <tr>
    <td>Company Name </td>
    <td><input name="company_name" type="text" id="company_name" tabindex="5" size="25" maxlength="50" /></td>
  </tr>
  <tr>
    <td>Slogan</td>
    <td><input name="slogan" type="text" id="slogan" tabindex="6" size="25" maxlength="100" /></td>
  </tr>
  <tr>
    <td>Full Name </td>
    <td><input name="name" type="text" id="name" tabindex="7" size="25" maxlength="50" /></td>
  </tr>
  <tr>
    <td>Job Title </td>
    <td><input name="title" type="text" id="title" tabindex="8" size="25" maxlength="25" /></td>
  </tr>
  <tr>
    <td>Address - Line 1 </td>
    <td><input name="address_1" type="text" id="address_1" tabindex="9" size="25" maxlength="100" /></td>
  </tr>
  <tr>
    <td>Address - Line 2 </td>
    <td><input name="address_2" type="text" id="address_2" tabindex="10" size="25" maxlength="100" /></td>
  </tr>
  <tr>
    <td>Address - Line 3 </td>
    <td><input name="address_3" type="text" id="address_3" tabindex="11" size="25" maxlength="100" /></td>
  </tr>
  <tr>
    <td>Telephone</td>
    <td><input name="phone" type="text" id="phone" tabindex="12" size="25" maxlength="15" /></td>
  </tr>
  <tr>
    <td>Cell </td>
    <td><input name="cell" type="text" id="cell" tabindex="13" size="25" maxlength="15" /></td>
  </tr>
  <tr>
    <td>Fax</td>
    <td><input name="fax" type="text" id="fax" tabindex="14" size="25" maxlength="15" /></td>
  </tr>
  <tr>
    <td>e-mail Address </td>
    <td><input name="vis_email" type="text" id="vis_email" tabindex="15" size="25" maxlength="50" /></td>
  </tr>
  <tr>
    <td>Website Address </td>
    <td><input name="website" type="text" id="website" tabindex="16" size="25" maxlength="100" /></td>
  </tr>
  <tr>
    <td>Additional Info </td>
    <td><input name="add_info" type="text" id="add_info" tabindex="17" size="25" maxlength="100" /></td>
  </tr>
  <tr>
    <td><label></label></td>
    <td>&nbsp;</td>
  </tr>
</table> </td>
    <td width="50%" align="center" valign="top"><table width="350" height="200" border="0" align="center" cellpadding="0" cellspacing="10" background="<background selection>">
      <tr>
        <td rowspan="2">company_name </td>
        <td><div align="right">name </div></td>
      </tr>
      <tr>
        <td><div align="right">title</div></td>
      </tr>
      <tr>
        <td colspan="2" align="center">slogan</td>
        </tr>
      <tr>
        <td>address_1</td>
        <td align="right">phone</td>
      </tr>
      <tr>
        <td>address_2</td>
        <td align="right">cell</td>
      </tr>
      <tr>
        <td>address_2</td>
        <td align="right">fax</td>
      </tr>
      <tr>
        <td>website</td>
        <td align="right">&bull; vis_email </td>
      </tr>
      <tr>
        <td colspan="2" align="center">add_info</td>
        </tr>
    </table>
    <br />
    <label>
    <input name="approval" type="checkbox" id="approval" value="approve" />
    </label>
I approve Design! (required)<br />
<br />
<input type="submit" name="Submit" value="Submit Design!" /></td>
  </tr>
</table> 
</form>
</body>
</html>