#!/usr/local/bin/perl -w
use strict;
use CGI
my $q = CGI::new();
  print <<HTML;
  <form action="name of this script.cgi">
  Name: <input type="text" name="Name" value="$q->param{'Name'}">
  Address: <input type="text" name="Address" value="$q->param{'Address'}">
  <input type="submit" value="Refresh">
  </form>
HTML