I have read my threads on these forums regarding this, but for whatever reason I absolutely can not get the code to work for myself. Here is the address that I am attempting it on.

http://208.62.119.11/picayuneprices/test.php

And here is the sample php code:

PHP Code:
<?PHP
$username
="*****";
$password="******";
$database="*******";

mysql_connect(localhost,$username,$password);

@
mysql_select_db($database) or die( "Unable to select database");       
$query"SELECT * FROM gastable ORDER BY Name ASC";
$result=mysql_query($query)or die( mysql_error());
?>
<?PHP
$username
="*****";
$password="*****";
$database="*****";
$counter=1;

mysql_connect(localhost,$username,$password);

@
mysql_select_db($database)>

<
html>
<
head>
<
script>
function 
fillFields(oSel)
{
var 
oForm oSel.form;
switch (
oSel.options[oSel.selectedIndex].value)
{
case 
'1':oForm.field1.value=$row[1];oForm.field2.value=$row[2];break;
case 
'2':oForm.field1.value='blah2';oForm.field2.value='foo2';break;
case 
'3':oForm.field1.value='blah3';oForm.field2.value='foo3';break;
}
}
</script>
</head>
<form>
<select name="T" onchange="fillFields(this)">
<option value="1">item 1</option>
<option value="2">item 2</option>
<option value="3">item 3</option>
</select>
<input type="text" name="field1" />
<input type="text" name="field2" />
</form>
</body>
</html>
This code is a frankentstein of code that I found on these forums. basically at this point I don't care what is suggested so long as it works.

I do not know how to get the fancy table code printout, but basically it has the following columns:

ID int
Name text
Address text
Regular decimal(3,2)
Middle decimal(3,2)
Premium decimal(3,2)
Timestamp bigint

My main goal is to create a drop down box that is populated by the station name and address in this format "$Name" - "$Address". Then once the user selects that it will auto populate the name, and address text boxes in the form. If you need any more info please just let me know.