use strict;
use CGI;
my $q = new CGI;
	
my $name    = $q -> param('name');
my $address = $q -> param('address');
my $city    = $q -> param('city');
my $state   = $q -> param('state');
my $zip     = $q -> param('zip');
my $phone   = $q -> param('phone');
and so on....