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<html>
<body>
<form enctype="multipart/form-data" method=post action="upload_sysinfo_report.php">
Client: <input name="client" type="text"><br />
Machine: <input name="hostname" type="text"><br />
Serial: <input name="serialnumber" type="text"><br />
Report Date: <input name='report_date' type='text' ><br />
Report File: <input name="report" type="file"><br />
<input type="submit" value="Send!">
</form>
</body>
</html>