<?
//
//  cP Account Creator Version 0.4 Beta Build 01
//  Copyright (C) 2004 Brian Freeman
//  All Rights Reserved.
//
//  This script set is distributed as is with absolutely no warranty.
//  Users of this script set agree to use at their own risk.
//  Questions or comments?  Contact webmaster@freemans-web.com
//
//
//
?>

<form method="POST" action="lostpw.php">



<table class=mtable>



<tr>

<td class=mtext>

First Name:

</td>

<td><input type="text" name="first_name">

</td>

</tr>

<tr>

<td class=mtext>

Last Name:

</td>

<td><input type="text" name="last_name">

</td>

</tr>

<tr>

<td class=mtext>

Alternate Email:

</td>

<td><input type="text" name="alt_email">

</td>

</tr>
<tr>

<td class=mtext>

Username:

</td>

<td><input type="text" name="username">

</td>

</tr>

<input type="hidden" name="user_ip" value=<? echo $_SERVER[REMOTE_ADDR];?>>

<? $rem_host=gethostbyaddr($_SERVER['REMOTE_ADDR']); ?>
<input type="hidden" name="user_host" value=<? echo $rem_host;?>>

<tr>

<td>&nbsp;</td>

<td>&nbsp;</td>

</tr>

<tr>

<td><input type="submit" value="Submit"></td>

</tr>

</table>



</form>

</table>

</body>

</html>
