__OUTPUT__

    <select name="name2 ">

        <option value="value1">
          value1
        </option>

        <option value="value2">
          value2
        </option>

        <option value="value3">
          value3
        </option>

    </select>

  <br>


    <input type="text" name="name1 " value=" ">

  <br>