<BR>
<CENTER>

<B><FONT face="verdana, arial" size=3>
- Edit {{contact_type}} Contact -
<font></b><BR><BR>

{{cc_warning}}

<form method=post action="{{CGI}}">
<input type=hidden name=action value="do_modify_contact">
<input type=hidden name=type value="{{type}}">

<TABLE BORDER=1 width=550 cellpadding=3 cellspacing=0>
<TR>
<TD COLSPAN=2 bgcolor="#d0d0d0" align=center>
<B><FONT face="verdana, arial" size=2>
{{contact_type}} Contact Information</FONT></B>
</TD>
</TR>
{{language_type_field}}
<TR>
<TD ALIGN=right bgcolor="#d0d0d0">
<font face="verdana, arial" size=2><B>Title:</B></font></TD>
<TD><input name="title" size=3 value="{{title}}"><br><i>See bottom for valid value</i></TD>
</TR>
<TR>
<TD ALIGN=right bgcolor="#d0d0d0">
<font face="verdana, arial" size=2><B>First Name:</B></font></TD>
<TD><input name="first_name" size=15 value="{{first_name}}"></TD>
</TR>
<TR>
<TD ALIGN=right bgcolor="#d0d0d0">
<font face="verdana, arial" size=2><B>Middle Name:</B></font></TD>
<TD><input name="midle_name" size=15 value="{{midle_name}}"></TD>
</TR>
<TR>
<TD ALIGN=right bgcolor="#d0d0d0">
<font face="verdana, arial" size=2><B>Last Name:</B></font></TD>
<TD><input name="last_name" size=15 value="{{last_name}}"></TD>
</TR>
{{nationality_field}}
<TR>
<TD ALIGN=right bgcolor="#d0d0d0">
<font face="verdana, arial" size=2><B>Company:</B></font></TD>
<TD><input name="org_name" size=39 value="{{org_name}}"></TD>
</TR>
<TR>
<TD ALIGN=right bgcolor="#d0d0d0">
<font face="verdana, arial" size=2><B>Job Title:</B></font></TD>
<TD><input name="job_title" size=15 value="{{job_title}}"></TD>
</TR>
<TR>
<TD ALIGN=right bgcolor="#d0d0d0">
<font face="verdana, arial" size=2><B>Additional Delivery Information</B></font></TD>
<TD><input name="addr_corporative" size=39 value="{{addr_corporative}}"></TD>
</TR>
<TR>
<TD ALIGN=right bgcolor="#d0d0d0">
<font face="verdana, arial" size=2><B>Civic Number:</B></font></TD>
<TD><input name="addr_address_number" size=39 value="{{addr_address_number}}"></TD>
</TR>
<TR>
<TD ALIGN=right bgcolor="#d0d0d0">
<font face="verdana, arial" size=2><B>Street Type:</B></font></TD>
<TD><input name="addr_street_cat" size=2 value="{{addr_street_cat}}"><br><i> See valid values at the bottom</i></TD>
</TR>
<TR>
<TD ALIGN=right bgcolor="#d0d0d0">
<font face="verdana, arial" size=2><B>Street Name:</B></font></TD>
<TD><input name="addr_street_name" size=39 value="{{addr_street_name}}"></TD>
</TR>
<TR>
<TD ALIGN=right bgcolor="#d0d0d0">
<font face="verdana, arial" size=2><B>Street Orientation:</B></font></TD>
<TD><input name="addr_orientation" size=2 value="{{addr_orientation}}"><br><i> See valid values at the bottom</i></TD>
</TR>
<TR>
<TD ALIGN=right bgcolor="#d0d0d0">
<font face="verdana, arial" size=2><B>Office Number:</B></font></TD>
<TD><input name="addr_office" size=39 value="{{addr_office}}"></TD>
</TR>
<TR>
<TD ALIGN=right bgcolor="#d0d0d0">
<font face="verdana, arial" size=2><B>City:</B></font></TD>
<TD><input name="city" size=15 value="{{city}}"></TD>
</TR>
<TR>
<TD ALIGN=right bgcolor="#d0d0d0">
<font face="verdana, arial" size=2><B>State/Province:</B></font></TD>
<TD><input name="state" size=15 value="{{state}}"></TD>
</TR>
<TR>
<TD ALIGN=right bgcolor="#d0d0d0">
<font face="verdana, arial" size=2><B>Country</B></font></TD>
<TD>
<select name=country>
{{COUNTRY_LIST}}
</select>
</TD>
</TR>
<TR>
<TD ALIGN=right bgcolor="#d0d0d0">
<font face="verdana, arial" size=2><B>Postal Code:</B></font></TD>
<TD><input name="postal_code" size=15 value="{{postal_code}}"></TD>
</TR>
<TR>
<TD ALIGN=right bgcolor="#d0d0d0">
<font face="verdana, arial" size=2><B>Phone Number:</B></font></TD>
<TD><input name="phone" size=40 value="{{phone}}">
    <font size=-1><br>(eg. 416-555-1122 x333)</font>
</TD>
</TR>
<TR>
<TD ALIGN=right bgcolor="#d0d0d0"><font color=red size=-1>
*optional*</font> <font face="verdana, arial" size=2><B>Fax Number:</B></font>
</TD>
<TD><input name="fax" size=40 value="{{fax}}">
    <font size=-1><br>(eg. 416-555-1122)</font>
</TD>
</TR>
<TR>
<TD ALIGN=right bgcolor="#d0d0d0">
<font face="verdana, arial" size=2><B>Email:</B></font></TD>
<TD><input name="email" size=39 value="{{email}}"></TD>
</TR>


</table>
<BR>
{{GLOBAL_CHANGE_MENU}}

<BR>
<input type=submit name=submit value="Save Configuration"> 
<input type=submit name=submit value="Cancel Changes">
<BR><BR><BR>
</center>

<ul>Title:
<li>MR
<li>MRS
<li>MS
<li>DR
</ul>
<br>
<ul>Street Type:
<li>AV - Avenue
<li>BL - Boulevard
<li>CT - Court
<li>CR - Crescent
<li>DR - Drive
<li>HW - Highway
<li>PL - Place
<li>PZ - Plaza
<li>RD - Road
<li>SQ - Square
<li>ST - Street
<li>WY - Way
</ul>
<br>
<ul>Street Orientation:
<li>E - East
<li>N - North
<li>NE - North-East
<li>NW - North-West
<li>S - South
<li>SE - South-East
<li>SW - South-West
<li>W - West
<br>


