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Код

<html><body>
<form name="form_name">
<input type="text" name="q1" />
<select name="sel4">
<option value="3">qwe</option>
<option value="5">yuio</option>
</select>
</form>
<script>
function qw() {
    var f = document.forms['form_name'];;
    var ar = new Array(), j = 0;
    var ic = f.elements.length;
    for(var i = 0; i < ic; i++) {
        ar[j] = [f.elements[i].name, f.elements[i].value];
        j++;
    }

    var d = document.getElementById('res');
    d.innerHTML = '<table id="tab"></table>';
    var t = document.getElementById('tab');
    var row, cell;
        row = t.insertRow(0);
        cell = row.insertCell(0);
        cell.innerHTML = 'name';
        cell = row.insertCell(1);
        cell.innerHTML = 'value';
   for(i = 0; i < j; i++) {
        row = t.insertRow(i + 1);
        cell = row.insertCell(0);
        cell.innerHTML = ar[i][0];
        cell = row.insertCell(1);
        cell.innerHTML = ar[i][1];
    }
}
</script>
<input type="button" value="сохранить" onclick="qw();" />
<div id="res"></div>

</body></html>