<?PHP
echo("
<form action='".$PHP_SELF."' method='POST'> 
<input type='hidden' name='sid' value='".trim($sid)."'>
".((isset($uid))?"<input type='hidden' name='uid' value='".trim($uid)."'>":"")."
".((isset($id))?"<input type='hidden' name='id' value='".trim($id)."'>":"")."
".((isset($oid))?"<input type='hidden' name='oid' value='".trim($oid)."'>":"")."
<table width='725' cellpadding='2' cellspacing='0' border='0'>
	<tr>
		<td width='30%' align='left' valign='top'><img src='".$http_images."/menu_arrow.gif'><b>Client Information</b></td>
		<td width='70%' align='left' valign='top'></td>
	</tr>
</table>
<table width='725' cellpadding='2' cellspacing='0' border='0'>
	<tr>
		<td width='30%' align='left' valign='top'><img src='".$http_images."/".((isset($err0))?"error_arrow.gif":"space.gif")."' width='15' height='9'>First Name:</td>
		<td width='70%' align='left' valign='top'><input ".$input_style." size='30' maxlength='255' type='text' name='first_name' value='".((isset($first_name))?"".trim(stripslashes($first_name))."":"")."'> [Required]</td>
	</tr>
	<tr>
		<td width='30%' align='left' valign='top'><img src='".$http_images."/".((isset($err1))?"error_arrow.gif":"space.gif")."' width='15' height='9'>Last Name:</td>
		<td width='70%' align='left' valign='top'><input ".$input_style." size='30' maxlength='255' type='text' name='last_name' value='".((isset($last_name))?"".trim(stripslashes($last_name))."":"")."'> [Required]</td>
	</tr>
	<tr>
		<td width='30%' align='left' valign='top'><img src='".$http_images."/space.gif' width='15' height='9'>Organization Name:</td>
		<td width='70%' align='left' valign='top'><input ".$input_style." size='30' maxlength='255' type='text' name='organization_name' value='".((isset($organization_name))?"".trim(stripslashes($organization_name))."":"")."'> [<font color='#990000'><i>Optional</i></font>]</td>
	</tr>
	<tr>
		<td width='30%' align='left' valign='top'><img src='".$http_images."/".((isset($err2))?"error_arrow.gif":"space.gif")."' width='15' height='9'>Street Address:</td>
		<td width='70%' align='left' valign='top'><input ".$input_style." size='30' maxlength='255' type='text' name='street_address_1' value='".((isset($street_address_1))?"".trim(stripslashes($street_address_1))."":"")."'> [Required]</td>
	</tr>
	<tr>
		<td width='30%' align='left' valign='top'></td>
		<td width='70%' align='left' valign='top'><input ".$input_style." size='30' maxlength='255' type='text' name='street_address_2' value='".((isset($street_address_2))?"".trim(stripslashes($street_address_2))."":"")."'> [<font color='#990000'><i>Optional</i></font>]</td>
	</tr>
	<tr>
		<td width='30%' align='left' valign='top'><img src='".$http_images."/".((isset($err3))?"error_arrow.gif":"space.gif")."' width='15' height='9'>City:</td>
		<td width='70%' align='left' valign='top'><input ".$input_style." size='30' maxlength='255' type='text' name='city' value='".((isset($city))?"".trim(stripslashes($city))."":"")."'> [Required]</td>
	</tr>
	<tr>
		<td width='30%' align='left' valign='top'><img src='".$http_images."/".((isset($err4))?"error_arrow.gif":"space.gif")."' width='15' height='9'>State/Province:</td>
		<td width='70%' align='left' valign='top'><input ".$input_style." size='30' maxlength='255' type='text' name='state' value='".((isset($state))?"".trim(stripslashes($state))."":"")."'> [Required]</td>
	</tr>
	<tr>
		<td width='30%' align='left' valign='top'><img src='".$http_images."/".((isset($err5))?"error_arrow.gif":"space.gif")."' width='15' height='9'>Postal Code:</td>
		<td width='70%' align='left' valign='top'><input ".$input_style." size='30' maxlength='255' type='text' name='zip_code' value='".((isset($zip_code))?"".trim(stripslashes($zip_code))."":"")."'> [Required]</td>
	</tr>
	<tr>
		<td width='30%' align='left' valign='top'><img src='".$http_images."/".((isset($err6))?"error_arrow.gif":"space.gif")."' width='15' height='9'>Country:</td>
		<td width='70%' align='left' valign='top'>
	");
@country($country,$input_style);
echo("
		<img src='".$http_images."/space.gif' width='5' height='9'>[Required]</td>
	</tr>
	<tr>
		<td width='30%' align='left' valign='top'><img src='".$http_images."/".((isset($err7))?"error_arrow.gif":"space.gif")."' width='15' height='9'>Phone Number:</td>
		<td width='70%' align='left' valign='top'><input ".$input_style." size='30' maxlength='255' type='text' name='phone' value='".((isset($phone))?"".trim(stripslashes($phone))."":"")."'> [Required]</td>
	</tr>
	<tr>
		<td width='30%' align='left' valign='top'><img src='".$http_images."/space.gif' width='15' height='9'>Fax Number:</td>
		<td width='70%' align='left' valign='top'><input ".$input_style." size='30' maxlength='255' type='text' name='fax' value='".((isset($fax))?"".trim(stripslashes($fax))."":"")."'> [<font color='#990000'><i>Optional</i></font>]</td>
	</tr>
	");
if (!isset($uid))
	{
	echo("
	<tr>
		<td width='30%' align='left' valign='top'><img src='".$http_images."/".((isset($err8))?"error_arrow.gif":"space.gif")."' width='15' height='9'>eMail Address:</td>
		<td width='70%' align='left' valign='top'><input ".$input_style." size='30' maxlength='255' type='text' name='email' value='".((isset($email))?"".trim(stripslashes($email))."":"")."'> [Required]</td>
	</tr>
		");
	}
else
	{
	echo("
	<tr>
		<td width='30%' align='left' valign='top'><img src='".$http_images."/".((isset($err8))?"error_arrow.gif":"space.gif")."' width='15' height='9'>eMail Address:</td>
		<td width='70%' align='left' valign='top'><a href='mailto:".trim(stripslashes($email))."'>".trim(stripslashes($email))."</a></td>
	</tr>
		");
	}
if (!isset($uid))
	{
	echo("
	<tr>
		<td width='30%' align='left' valign='top'><img src='".$http_images."/".((isset($err9))?"error_arrow.gif":"space.gif")."' width='15' height='9'>Client Area Username:</td>
		<td width='70%' align='left' valign='top'><input ".$input_style." size='30' maxlength='255' type='text' name='username' value='".((isset($username))?"".trim(stripslashes($username))."":"")."'> [Required]</td>
	</tr>
		");
	}
else
	{
	echo("
	<tr>
		<td width='30%' align='left' valign='top'><img src='".$http_images."/".((isset($err9))?"error_arrow.gif":"space.gif")."' width='15' height='9'>Client Area Username:</td>
		<td width='70%' align='left' valign='top'>".trim(stripslashes($username))."</td>
	</tr>
		");
	}
echo("
	<tr>
		<td width='30%' align='left' valign='top'><img src='".$http_images."/".((isset($err10))?"error_arrow.gif":"space.gif")."' width='15' height='9'>".((isset($uid))?"Change":"Choose")." Password:</td>
		<td width='70%' align='left' valign='top'><input ".$input_style." size='30' maxlength='255' type='text' name='password' value=''> [Required]</td>
	</tr>
	<tr>
		<td width='30%' align='left' valign='top'><img src='".$http_images."/".((isset($err10))?"error_arrow.gif":"space.gif")."' width='15' height='9'>Verify Password:</td>
		<td width='70%' align='left' valign='top'><input ".$input_style." size='30' maxlength='255' type='text' name='password2' value=''> [Required]</td>
	</tr>
	<tr>
		<td width='30%' align='left' valign='top'><img src='".$http_images."/space.gif' width='15' height='9'>Choose Hosting Package:</td>
		<td width='70%' align='left' valign='top'><select name='xpid' ".$input_style.">
	");
$row2=mysql_query("select pid, package_name, monthly_cost, quarterly_cost, semi_annual_cost, annual_cost from plan_specs order by package_name asc");
while ($rs2=mysql_fetch_row($row2))
	{
	if ($rs2[2]!=-1)
		{
		echo"<option value='".$rs2[0]."|monthly'".((isset($pid))?"".(($pid==$rs2[0]."|monthly")?" selected":"")."":"").">".$rs2[1]." - ".$rs2[2]." Monthly</option>\n";
		}
	if ($rs2[3]!=-1)
		{
		echo"<option value='".$rs2[0]."|quarterly'".((isset($pid))?"".(($pid==$rs2[0]."|quarterly")?" selected":"")."":"").">".$rs2[1]." - ".$rs2[3]." Quarterly</option>\n";
		}
	if ($rs2[4]!=-1)
		{
		echo"<option value='".$rs2[0]."|semi_annual'".((isset($pid))?"".(($pid==$rs2[0]."|semi_annual")?" selected":"")."":"").">".$rs2[1]." - ".$rs2[4]." Semi-Annually</option>\n";
		}
	if ($rs2[5]!=-1)
		{
		echo"<option value='".$rs2[0]."|annual'".((isset($pid))?"".(($pid==$rs2[0]."|annual")?" selected":"")."":"").">".$rs2[1]." - ".$rs2[5]." Annually</option>\n";
		}
	}
echo("
		</select></td>
	</tr>


		<tr>
			<td width='30%' align='left' valign='top'><img src='".$http_images."/space.gif' width='15' height='9'>Domain Name:</td>
			<td width='70%' align='left' valign='top'>http:// <input ".$input_style." size='35' maxlength='255' type='text' name='domain_name' value='".trim($domain_name)."'></td>
		</tr>
		<tr>
			<td width='30%' align='left' valign='top'><img src='".$http_images."/space.gif' width='15' height='9'>Domain Expires:</td>
			<td width='70%' align='left' valign='top'><input ".$input_style." size='15' maxlength='255' type='text' name='domain_expire' value='".((strlen(trim(str_replace("/", "", $domain_expire)))!=0)?"".$domain_expire."":"")."'> ex. MM/DD/YYYY</td>
		</tr>
		</tr>
			<td width='30%' align='left' valign='top'><img src='".$http_images."/space.gif' width='15' height='9'>Resolve Status:</td>
			<td width='70%' align='left' valign='top'><input type='checkbox' name='resolved' value='1'".((isset($resolved))?"".((trim($resolved)=="1")?" checked":"")."":"")."> Check to mark as resolved.</td>
		</tr>
		<tr>
			<td width='30%' align='left' valign='top'><img src='".$http_images."/space.gif' width='15' height='9'>Monitor Resolve status:</td>
			<td width='70%' align='left' valign='top'><input type='checkbox' name='cont_resolve' value='1'".((isset($cont_resolve))?"".((trim($cont_resolve)=="1")?" checked":"")."":"")."> Check for yes.</td>
		</tr>


	<tr>
		<td colspan='2'><img src='".$http_images."/space.gif' width='1' height='10'></td>
	</tr>
	<tr>
		<td width='30%' align='left' valign='top'></td>
		<td width='70%' align='left' valign='top'><input ".$button_style." type='submit' name='submit' value='Submit Client Information &gt&gt'></td>
	</tr>
</table>
</form>
	");
?>