Hello I am trying to create a table similar to the one in the picture. 2 Rows with multiple columns where the text (or titles) are to the left and centered on top of the input fields. Please help me with the code or direct me to a page that shows this HTML/CSS information. i do not know what this would be called. Thanks!

http://i1108.photobucket.com/albums/h418/chicagomerchant/Screenshot2012-11-12at111612PM.png