<form method="get" action="http://www.google.com/search" id="googlesearch">

   <input type="hidden" name="domains" value="http://hoefsloot.com" />
   <input type="hidden" name="num" value="50" />
   <input type="hidden" name="ie" value="$2" />
   <input type="hidden" name="oe" value="$2" />

   <input type="text" name="q" size="31" maxlength="255" value="$1" />
   <input type="submit" name="btnG" value="$3" />

   <input type="radio" name="sitesearch" id="gwiki" value="http://hoefsloot.com" checked="checked" /><label for="gwiki">CM Box User Guide</label>
   <input type="radio" name="sitesearch" id="gWWW" value="" /><label for="gWWW">WWW</label>

</form>