Create a form related issues

Build a form problem
I want to build a form like this


Rookie one, find similar code on the Internet, modify a pass, the effect is not what you think


Want to realize the function, the product is listed in the database of all goods, in the box to select the representative to buy the product, ask for guidance. The code is as follows，





<title>Product Enquiry</title>

 !--? phpinclude (' conn.php ');//Connect to database. mysql_query ("Use Sale_system"), $sql =mysql_query ("Select commodity from Stock"), $info =mysql_fetch_array ($sql); do{?> buy trade name send single period Order notes