<html>
<head>
<meta http-equiv="Content-Type"
content="text/html; charset=iso-8859-1" />
<!--
Copyright (c) 2001, Keith Wong
Permission is hereby granted, free of charge, to any person obtaining a copy of this software
and associated documentation files (the "Software"), to deal in the Software without restriction,
including without limitation the rights to use, copy, modify, merge, publish, distribute,
sublicense, and/or sell copies of the Software, and to permit persons to whom the Software
is furnished to do so, subject to the following conditions:
The above copyright notice and this permission notice shall be included in all copies or
substantial portions of the Software.
THE SOFTWARE IS PROVIDED "AS IS", WITHOUT WARRANTY OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING
BUT NOT LIMITED TO THE WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE AND
NONINFRINGEMENT. IN NO EVENT SHALL THE AUTHORS OR COPYRIGHT HOLDERS BE LIABLE FOR ANY CLAIM,
DAMAGES OR OTHER LIABILITY, WHETHER IN AN ACTION OF CONTRACT, TORT OR OTHERWISE, ARISING FROM,
OUT OF OR IN CONNECTION WITH THE SOFTWARE OR THE USE OR OTHER DEALINGS IN THE SOFTWARE.
-->
<style type="text/css">
.heading {
FONT-WEIGHT: bold; FONT-SIZE: 12pt; COLOR: #000000;
FONT-FAMILY: Arial,sans-serif
}
.normal {
FONT-WEIGHT: normal; FONT-SIZE: 10pt; COLOR: #000000;
FONT-FAMILY: Arial,sans-serif
}
.info {
FONT-WEIGHT: normal; FONT-SIZE: 10pt; COLOR: #0000ff;
FONT-FAMILY: Arial,sans-serif
}
.error {
FONT-WEIGHT: normal; FONT-SIZE: 10pt; COLOR: #ff0000;
FONT-FAMILY: Arial,sans-serif
}
</style>
<title>
</title>
</head>
<body bgcolor="white">
<p class="heading">Customer Details</p>
<p class="normal">All fields with an asterix (*) are mandatory
fields.</p>
<form name="customerform" method="post">
<p class="normal" id="m_parUserMessage">
<span id="m_htmUserMessage"></span>
</p>
<table class="normal" bgcolor="#FCFADA" border="0" id="m_tblLayout">
<tr>
<td>Title *</td>
<td>
<select name="m_selTitle">
<option value="" selected="selected">- Choose Title -</option>
<option value="01">Mr</option>
<option value="02">Miss</option>
<option value="03">Ms</option>
<option value="04">Mrs</option>
</select>
</td>
</tr>
<tr>
<td>First Name *</td>
<td>
<input type="text" name="m_txtFirstName" />
</td>
</tr>
<tr>
<td>Last Name *</td>
<td>
<input type="text" name="m_txtLastName" />
</td>
</tr>
<tr>
<td>Birth Date</td>
<td>
<input type="text" name="m_txtBirthDate" />
</td>
</tr>
<tr>
<td>Gender</td>
<td>M
<input type="radio" value="M" name="m_radGender" checked="checked" id="m_radMale" />
F
<input type="radio" value="F" name="m_radGender" id="m_radFemale" />
</td>
</tr>
<tr>
<td>Street</td>
<td>
<textarea name="m_txaStreet" rows="3" cols="40"></textarea>
</td>
</tr>
<tr>
<td>Post Code</td>
<td>
<input type="text" onchange="document.customerform.submit();" name="m_txtPostCode" />
</td>
</tr>
<tr>
<td>Suburb</td>
<td>
<input type="text" name="m_txtSuburb" />
</td>
</tr>
<tr>
<td>State</td>
<td>
<input type="text" name="m_txtState" />
</td>
</tr>
<tr>
<td>Same as postal address?</td>
<td>
<input type="checkbox" value="Y" name="m_cbxPostalAddress" />
</td>
</tr>
<tr>
<td>Telephone</td>
<td>
<input type="text" name="m_txtTelephone" />
</td>
</tr>
<tr>
<td>Email *</td>
<td>
<input type="text" size="50" name="m_txtEmail" />
</td>
</tr>
<tr bgcolor="#D7FFFF">
<td align="middle" colspan="2">
<input type="submit" value="Save" name="m_btnSave" />
<input type="reset" value="Reset" name="m_btnReset" />
</td>
</tr>
</table>
</form>
</body>
</html>