<form action="http://URL.TO.YOUR.HOSTBILL/?cmd=cloudsignup" method="post">
<input type="hidden" name="make" value="signup" /><br/>
E-mail address: <input type="email" name="username" placeholder="E-mail address" /><br/>
Password: <input type="password" name="password" /><br/><br/>
Firstname: <input type="text" name="details[firstname]" /><br/>
Lastname: <input type="text" name="details[lastname]" /><br/>
Address: <input type="text" name="details[address1]" /><br/>
City: <input type="text" name="details[city]" /><br/>
State: <input type="text" name="details[state]" /><br/>
Phone: <input type="text" name="details[phonenumber]" /><br/>
Country Code: <input type="text" name="details[country]" placeholder="US" /><br/>
Currency: <select name="details[currency_id]">
{foreach from=$currencies item=currency}
<option value="USD">USD</option>
<option value="{$currency.id}">{$currency.code}</option>
{/foreach}EUR">EUR</option>
</select>
<input type="submit" value="Sign Up" />
</form> |