<center>

<b>Primary contact creation.</b><br>
<p>

<TMPL_IF errors>
    <font color=red size=+1><b>Errors occurred:</b></font><br>
	<TMPL_VAR errors>
</TMPL_IF>

<form action="<tmpl_var cgi>" method="post">
<input type=hidden name="action" value="create_primary_contact">

<table border="0" cellpadding="5" cellspacing="1">
<tr class="accent">
    <td class="main" colspan=2 align=center>
	<font class="heading">Primary User Contact Form</font>
    </td>
</tr>
<tr>
    <td class="accent" align="right">First Name:</td>
    <td class="accent" align="left"><input type=text name="first_name"
	value="<TMPL_VAR NAME=first_name>" size=25 maxlength=100> <font color=red>*</a>
    </td>
</tr>
<tr>
    <td class="accent" align="right">Last Name:</td>
    <td class="accent" align="left"><input type=text name="last_name"
	value="<TMPL_VAR NAME=last_name>" size=25 maxlength=100> <font color=red>*</a>
    </td>
</tr>
<tr>
    <td class="accent" align="right">Street Address:</td>
    <td class="accent" align="left"><input type=text name="address1"
	value="<TMPL_VAR NAME=address1>" size=25 maxlength=100> <font color=red>*</a>
    </td>
</tr>
<tr>
    <td class="accent" align="right">City:</td>
    <td class="accent" align="left"><input type=text name="city"
	value="<TMPL_VAR NAME=city>" size=25 maxlength=100> <font color=red>*</a>
    </td>
</tr>
<tr>
    <td class="accent" align="right">State/Province:</td>
    <td class="accent" align="left"><input type=text name="state"
	value="<TMPL_VAR NAME=state>" size=25 maxlength=100> <font color=red>*</a>
    </td>
</tr>
<tr>
    <td class="accent" align="right">Zip/Postal Code:</td>
    <td class="accent" align="left"><input type=text
	name="postal_code" value="<TMPL_VAR NAME=postal_code>"
	size=25 maxlength=100> <font color=red>*</a>
    </td>
</tr>
<tr>
    <td class="accent" align="right">Country:</td>
    <td class="accent" align="left">
	<select name="country">
	    <TMPL_VAR NAME=country_select>
	</select> <font color=red>*</a>
    </td>
</tr>
<tr>
    <td class="accent" align="right">Phone:</td>
    <td class="accent" align="left"><input type=text
	name="phone" value="<TMPL_VAR NAME=phone>"
	size=25 maxlength=25>&nbsp;&nbsp;
	<font size="-1">(eg. +1.4165551122x1234)</font> <font color=red>*</a>
    </td>
</tr>
<tr>
    <td class="accent" align="right">Email:</td>
    <td class="accent" align="left"><input type=text name="email"
	value="<TMPL_VAR NAME=email>" size=25 maxlength=100> <font color=red>*</a>
    </td>
</tr>
<tr>
    <td class="accent" align="right">URL:</td>
    <td class="accent" align="left"><input type=text name="url"
	value="<TMPL_VAR NAME=url>" size=25 maxlength=100>
    </td>
</tr>

<tr>
    <td class="accent" align="left" colspan="2">
	<font color=red>* - Mandatory fields</font>
    </td>
</tr>

<tr>
    <td class="main" align="center" colspan="2">
	<input type="submit" value=" Create Contact ">
    </td>
</tr>

</table>

</form>

</center>
