Reponse-O-Matic Trouble

[fainaru]

I'm having some trouble getting this cheezy e-mail form to work. How do I insert more questions for ppl to answer and actually receive it in my inbox. I have some of the code below. I'm sure the problem is in the NAME part but I'm a little confused. You can ignore the e-mails and such too.

Code:

<FORM action="http://www.response-o-matic.com/cgi-bin/rom.pl" method="POST">
<INPUT TYPE="hidden" NAME="your_email_address"
VALUE="blinkzt3r@yahoo.ca">
<INPUT TYPE="hidden" NAME="your_name"
VALUE="Blinkzter">
<INPUT TYPE="hidden" NAME="email_subject_line"
VALUE="E-mail">
<INPUT TYPE="hidden" NAME="required_fields" VALUE="your_email_address">
<INPUT TYPE="hidden" NAME="thank_you_title"
VALUE="Thank You">
<INPUT TYPE="hidden" NAME="return_link_url"
VALUE="http://www.hyperion-angel.com/blinkzter/request.php">
<INPUT TYPE="hidden" NAME="return_link_name"
VALUE="Return to Blinkzter">
<INPUT TYPE=hidden NAME="background_color"
VALUE="#FEAE65">
<INPUT TYPE="hidden" NAME="text_color"
VALUE="#000000">
<INPUT TYPE="hidden" NAME="link_color"
VALUE="#000000">
<INPUT TYPE="hidden" NAME="visited_link_color"
VALUE="#000000">
<INPUT TYPE="hidden" NAME="active_link_color"
VALUE="#000000">
</CENTER></H3>

Name: <INPUT TYPE="text" NAME="visitor_name" VALUE="" SIZE=30><br><br>
Email: <INPUT TYPE="text" NAME="visitor_email_address" VALUE=""
SIZE=30><br><br><br><br>Font: <INPUT TYPE="text" NAME="required_fields" VALUE="" SIZE=30><br><br>Border Colour: <INPUT TYPE="text" NAME="required_fields" VALUE="" SIZE=30><br><br>Text Colour: <INPUT TYPE="text" NAME="required_fields" VALUE="" SIZE=30><br><br>Blinkie Background Colour: <INPUT TYPE="text" NAME="required_fields" VALUE="Solid Colour or 2 Repeated Colours" SIZE=30><br><br>Images: <INPUT TYPE="text" NAME="required_fields" VALUE="Refer to URL of GIFS or Pixels" SIZE=30><br><br>References: <INPUT TYPE="text" NAME="required_fields" VALUE="" SIZE=30><br><br>
Extra:<br><TEXTAREA NAME="Extra" ROWS=5 COLS=27></TEXTAREA><br><br>
<INPUT TYPE="submit" NAME="Submit"
VALUE="Submit">&nbsp;&nbsp;&nbsp;<INPUT TYPE="reset" VALUE="Reset">
</FORM>