Revision 1991
Added by Matt Jones over 20 years ago
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</p> |
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<table border="0" cellspacing="0" cellpadding="9" width="760" bgcolor="#c6d6e7"> |
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<tr> |
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<td valign="TOP" colspan="3"><font size="-1" color="#ff0000">
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<td valign="TOP" colspan="3"> |
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<input type="CHECKBOX" name="useOrigAddress" [%useOrigAddress%]> |
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Use the same address as DATA SET ORIGINATOR above (If you check this box, |
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you don't need to fill in the address fields below). </font></td>
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you don't need to fill in the address fields below).</td> |
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</tr> |
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<tr> |
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<td valign="TOP" colspan="8"> |
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<p><font size="-1">
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<p> |
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<input type="TEXT" name="origNamefirstContact" value="[%origNamefirstContact%]" size="40"> |
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<b><font color="#ff0000">*</font>First Name</b></font></p>
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<p><font size="-1">
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<b><font color="#ff0000">*</font>First Name</b></p> |
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<p> |
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<input type="TEXT" name="origNamelastContact" value="[%origNamelastContact%]" size="40"> |
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<b><font color="#ff0000">*</font>Last Name</b></font></p>
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<p><font size="-1">
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<b><font color="#ff0000">*</font>Last Name</b></p> |
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<p> |
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<input type="TEXT" name="origNameOrgContact" value="[%origNameOrgContact%]" size="60"> |
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<b>Organization Name</b></font></p>
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<p><font size="-1"><b>Originator Address Information (for Individual or
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Organization):</b></font></p>
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<p><font size="-1">
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<b>Organization Name</b></p> |
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<p><b>Originator Address Information (for Individual or |
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Organization):</b></p> |
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<p> |
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<input type="TEXT" name="origEmailContact" value="[%origEmailContact%]"> |
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<b>E-Mail</b></font></p>
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<p><font size="-1">
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<b>E-Mail</b></p> |
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<p> |
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<input type="TEXT" name="origPhoneContact" value="[%origPhoneContact%]"> |
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<b>Phone</b></font></p>
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<p><font size="-1">
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<b>Phone</b></p> |
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<p> |
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<input type="TEXT" name="origFAXContact" value="[%origFAXContact%]"> |
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<b>FAX</b> </font></p> |
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<p><font size="-1"><b>Delivery information (number, street, unit, etc., |
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comma-separated)</b></font></p> |
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<p><font size="-1"> |
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<textarea rows="5" cols="60" name="origDeliveryContact">[%origDeliveryContact%]</textarea> |
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</font></p> |
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<p><font size="-1"> |
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<b>FAX</b></p> |
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<p><b>Delivery information (number, street, unit, etc., |
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comma-separated)</b></p> |
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<p> |
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<textarea rows="5" cols="60" name="origDeliveryContact">[%origDeliveryContact%]</textarea></p> |
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<p> |
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<input type="TEXT" name="origCityContact" value="[%origCityContact%]" size="50"> |
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<b>City</b></font></p>
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<b>City</b></p> |
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<p> |
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<select name="origStateContact"> |
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[% IF form == 're_entry' %] |
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<option>Wisconsin</option> |
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<option>Wyoming</option> |
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</select> |
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<b><font size="-1">State</font></b> |
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<font size="-1"> |
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<b>State</font></b> |
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<input type="TEXT" name="origStateOtherContact" value="[%origStateOtherContact%]"> |
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<b>Other State or Province</b></font>
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<b>Other State or Province</b> |
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</p> |
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<p><font size="-1">
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<p> |
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<input type="TEXT" name="origZIPContact" size="10" value="[%origZIPContact%]"> |
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<b>ZIP</b></font></p>
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<p><font size="-1">
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<b>ZIP</b></p> |
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<p> |
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<input type="TEXT" name="origCountryContact" value="[%origCountryContact%]"> |
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<b>Country</b></font></p>
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<b>Country</b></p> |
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</td> |
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</tr> |
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</table> |
Also available in: Unified diff
Revised the registry guide to include descriptions of the new fields, and
made some minor formatting changes.