my $q = new CGI; 

my @info = { 'address' => '123 Main',
                    'choices' => '2' };

my $template = HTML::Template->new( filename => "../form.tmpl");
my $html = $template->output;
my $form = new HTML::FillInForm;
my $page = $form->fill(scalarref  => \$html,
                                     fdat         => \@info);

print "Content-type: text/html\n\n";
print $page;