chromium/chrome/test/data/autofill/duplicate_profiles_test.html

<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01//EN">
<html>
  <head>
    <title>Autofill Form</title>
  </head>
  <body>
    <form id="testform" method="post">
      <p>
      <!-- Profile -->
      <!-- The form element names must match the keys in
      dataset_duplicate-profiles.txt -->
        <label for="NAME_FIRST">First Name:</label>
        <input type="text" id="NAME_FIRST" name="firstname"><br/>
        <label for="NAME_MIDDLE">Middle Name:</label>
        <input type="text" id="NAME_MIDDLE" name="middlename"><br/>
        <label for="NAME_LAST">Last Name:</label>
        <input type="text" id="NAME_LAST" name="lastname"><br/>
        <label for="EMAIL_ADDRESS">Email:</label>
        <input type="text" id="EMAIL_ADDRESS" name="email"><br/>
        <label for="COMPANY_NAME">Company:</label>
        <input type="text" id="COMPANY_NAME" name="company"><br/>

        <label for="ADDRESS_HOME_LINE1">Address:</label>
        <input type="text" id="ADDRESS_HOME_LINE1" name="address"><br/>
        <label for="ADDRESS_HOME_LINE2">Address 2:</label>
        <input type="text" id="ADDRESS_HOME_LINE2" name="address2"><br/>
        <label for="ADDRESS_HOME_CITY">City:</label>
        <input type="text" id="ADDRESS_HOME_CITY" name="city"><br/>
        <label for="ADDRESS_HOME_STATE">State:</label>
        <input type="text" id="ADDRESS_HOME_STATE" name="state"><br/>
        <label for="ADDRESS_HOME_ZIP">Zip:</label>
        <input type="text" id="ADDRESS_HOME_ZIP" name="zipcode"><br/>

        <label for="ADDRESS_HOME_COUNTRY">Country:</label>
        <input type="text" id="ADDRESS_HOME_COUNTRY" name="country"><br/>
        <label for="PHONE_HOME_WHOLE_NUMBER">Phone:</label>
        <input type="text" id="PHONE_HOME_WHOLE_NUMBER" name="phone"><br/>
        <input type="submit" value="send"> <input type="reset">
      </p>
    </form>
  </body>
</html>