<?PHP
echo("
<form action='".$PHP_SELF."' method='POST'> 
<input type='hidden' name='sid' value='".trim($sid)."'>
<input type='hidden' name='whm_id' value='".trim($whm_id)."'>
<table width='725' cellpadding='2' cellspacing='0' border='0'>
	<tr>
		<td colspan='2'><hr color='#F3F3F3'></td>
	</tr>
	<tr>
		<td width='25%' align='left' valign='top'><img src='".$http_images."/".((isset($err0))?"error_arrow.gif":"space.gif")."' width='15' height='9'>First Name:</td>
		<td width='75%' align='left' valign='top'><input ".$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='25%' align='left' valign='top'><img src='".$http_images."/".((isset($err1))?"error_arrow.gif":"space.gif")."' width='15' height='9'>Last Name:</td>
		<td width='75%' align='left' valign='top'><input ".$input_style." size='30' maxlength='255' type='text' name='last_name' value='".((isset($last_name))?"".trim(stripslashes($last_name))."":"")."'> [Required]</td>
	</tr>
	<tr>
		<td width='25%' align='left' valign='top'><img src='".$http_images."/space.gif' width='15' height='9'>Organization Name:</td>
		<td width='75%' align='left' valign='top'><input ".$input_style." size='30' maxlength='255' type='text' name='organization_name' value='".((isset($organization_name))?"".trim(stripslashes($organization_name))."":"")."'> [<font color='#990000'><i>Optional</i></font>]</td>
	</tr>
	<tr>
		<td width='25%' align='left' valign='top'><img src='".$http_images."/".((isset($err2))?"error_arrow.gif":"space.gif")."' width='15' height='9'>Street Address:</td>
		<td width='75%' align='left' valign='top'><input ".$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='25%' align='left' valign='top'></td>
		<td width='75%' align='left' valign='top'><input ".$input_style." size='30' maxlength='255' type='text' name='street_address_2' value='".((isset($street_address_2))?"".trim(stripslashes($street_address_2))."":"")."'> [<font color='#990000'><i>Optional</i></font>]</td>
	</tr>
	<tr>
		<td width='25%' align='left' valign='top'><img src='".$http_images."/".((isset($err3))?"error_arrow.gif":"space.gif")."' width='15' height='9'>City:</td>
		<td width='75%' align='left' valign='top'><input ".$input_style." size='30' maxlength='255' type='text' name='city' value='".((isset($city))?"".trim(stripslashes($city))."":"")."'> [Required]</td>
	</tr>
	<tr>
		<td width='25%' align='left' valign='top'><img src='".$http_images."/".((isset($err4))?"error_arrow.gif":"space.gif")."' width='15' height='9'>State/Province:</td>
		<td width='75%' align='left' valign='top'><input ".$input_style." size='30' maxlength='255' type='text' name='state' value='".((isset($state))?"".trim(stripslashes($state))."":"")."'> [Required]</td>
	</tr>
	<tr>
		<td width='25%' align='left' valign='top'><img src='".$http_images."/".((isset($err5))?"error_arrow.gif":"space.gif")."' width='15' height='9'>Postal Code:</td>
		<td width='75%' align='left' valign='top'><input ".$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='25%' align='left' valign='top'><img src='".$http_images."/".((isset($err6))?"error_arrow.gif":"space.gif")."' width='15' height='9'>Country:</td>
		<td width='75%' align='left' valign='top'>
	");
@country($country,$input_style);
echo("
		<img src='".$http_images."/space.gif' width='5' height='9'>[Required]</td>
	</tr>
	<tr>
		<td width='25%' align='left' valign='top'><img src='".$http_images."/".((isset($err7))?"error_arrow.gif":"space.gif")."' width='15' height='9'>Phone Number:</td>
		<td width='75%' align='left' valign='top'><input ".$input_style." size='30' maxlength='255' type='text' name='phone' value='".((isset($phone))?"".trim(stripslashes($phone))."":"")."'> [Required]</td>
	</tr>
	<tr>
		<td width='25%' align='left' valign='top'><img src='".$http_images."/space.gif' width='15' height='9'>Fax Number:</td>
		<td width='75%' align='left' valign='top'><input ".$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($uid))
	{
	echo("
	<tr>
		<td width='25%' align='left' valign='top'><img src='".$http_images."/".((isset($err8))?"error_arrow.gif":"space.gif")."' width='15' height='9'>eMail Address:</td>
		<td width='75%' align='left' valign='top'><input ".$input_style." size='30' maxlength='255' type='text' name='email' value='".((isset($email))?"".trim(stripslashes($email))."":"")."'> [Required]</td>
	</tr>
		");
	}
else
	{
	echo("
	<tr>
		<td width='25%' align='left' valign='top'><img src='".$http_images."/".((isset($err8))?"error_arrow.gif":"space.gif")."' width='15' height='9'>eMail Address:</td>
		<td width='75%' align='left' valign='top'><a href='mailto:".trim(stripslashes($email))."'>".trim(stripslashes($email))."</a></td>
	</tr>
		");
	}
if (!isset($uid))
	{
	echo("
	<tr>
		<td width='25%' align='left' valign='top'><img src='".$http_images."/".((isset($err9))?"error_arrow.gif":"space.gif")."' width='15' height='9'>Client Area Username:</td>
		<td width='75%' align='left' valign='top'><input ".$input_style." size='30' maxlength='255' type='text' name='username' value='".((isset($username))?"".trim(stripslashes($username))."":"")."'> [Required]</td>
	</tr>
		");
	}
else
	{
	echo("
	<tr>
		<td width='25%' 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='75%' align='left' valign='top'>".trim(stripslashes($username))."</td>
	</tr>
		");
	}
echo("
	<tr>
		<td width='25%' align='left' valign='top'><img src='".$http_images."/".((isset($err10))?"error_arrow.gif":"space.gif")."' width='15' height='9'>".((isset($uid))?"Change":"Choose")." Password:</td>
		<td width='75%' align='left' valign='top'><input ".$input_style." size='30' maxlength='255' type='text' name='password' value=''> [Required]</td>
	</tr>
	<tr>
		<td width='25%' align='left' valign='top'><img src='".$http_images."/".((isset($err10))?"error_arrow.gif":"space.gif")."' width='15' height='9'>Verify Password:</td>
		<td width='75%' align='left' valign='top'><input ".$input_style." size='30' maxlength='255' type='text' name='password2' value=''> [Required]</td>
	</tr>
	<tr>
		<td colspan='2'><img src='".$http_images."/space.gif' width='1' height='10'></td>
	</tr>
	<tr>
		<td width='25%' align='left' valign='top'></td>
		<td width='75%' align='left' valign='top'><input ".$button_style." type='submit' name='submit' value='Create User &gt&gt'></td>
	</tr>
</table>
</form>
	");
?>