Need help with a php form!

      Install Optin ? Still on the Appearance > Editor page, click the ?optin.php?
link. Replace the form elements in that file with those from your web  form and add any additional inputs that your web form may have.

     <div class="fatlossoptin">
  <div class="fatlossoptincontent">
  <!-- Customize the form below so it works with your email service  provider. Make sure you keep the classes for the inputs and submit  button -->
    <form method='POST' name='NAMEHERE' action='Weight-loss-Ebook'>

      <table width="240" border="0" cellspacing="0" cellpadding="5" align="center">
        <tr>
          <td width="71">Name:</td>
          <td width="169">
              <input type="text" name="textfield" id="NAMEIDHERE" class="text" />
            </td>
        </tr>
        <tr>
          <td>Email:</td>
          <td><input type="text" name="textfield2" id="EMAILIDHERE" class="text" /></td>
        </tr>
        <tr>
          <td colspan="2" align="center"><input type="submit" class="button" value=""/></td>
        </tr>
      </table>
    </form>
  </div>
</div>

<?php
$fullname = isset($_POST["fullname"]) ? $_POST["fullname"] : "";
$email = isset($_POST["emailaddress"]) ? $_POST["emailaddress"] : "";

// make sure you have table ready on your database
// f.i. table name is myoptin and it has fullname and emailaddress columns
mysql_query("INSERT INTO myoptin (fullname,emailaddress) VALUES ('".mysql_real_escape($fullname).'", '".mysql_real_escape($email)."')"
?>