need a form with html or asp

[login to view URL] follow this link write a form in html . 1 firlds Game - need Drop down XBOX PC name age(ovl) seller email qty payout [login to view URL] button with img 3 disallow left blank (if sone1 balnk, need pop up"please wrier your name") 4 code can copy and use for any page 5 beautiful, dreamy 6 after test no problem . payment and 5star feedback 7. fast fast fast Important ： after click submit button , MUSTshow and run full link ! **example filled " name: ABC" , it shold be show "name=ABC" in the link ***[login to view URL]