<li>
<div style="float:left;">
<label for="interest"> history:</label>
<select name="period" id="interest">
<option>less then three months</option>
<option>over three months</option>
<option>over half year</option>
</select>
<label for="interest">Where:</label>
<input name="where" type="text" value="" size="20" />
<label for="interest">Purpose:</label>
<input name="Purpose" type="text" value="" size="20" />
<label for="interest">other information :</label>
<input name="Other" type="text" value="" size="20" />
</div>

<div style="clear:both;"></div>
</li>