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Text File  |  1997-04-10  |  2.2 KB  |  42 lines
  1. <html>
  2. <head><title>*CatTitle*</title></head>
  3. <body BGCOLOR=#ffffff>
  4. <h1>*CatTitle*</h1>
  5. <form action="/cgi-win/backeng.exe" method=POST>
  6. <input type="HIDDEN" name="ScriptName" value="*CGIPath*process.cgi">
  7. <input type="HIDDEN" name="SessionID" value="*SeSiOnId*">
  8. <B>Shipping information</B><br>
  9. <table border>
  10. <tr><th>Name</th><td><input type="TEXT" name="SHIPNAME" size=40></td></tr>
  11. <tr><th>Title</th><td><input type="TEXT" name="SHIPTITLE" size=40></td></tr>
  12. <tr><th>Company</th><td><input type="TEXT" name="SHIPCOMPANY" size=40></td></tr>
  13. <tr><th>Address 1</th><td><input type="TEXT" name="SHIPADDR1" size=40></td></tr>
  14. <tr><th>Address 2</th><td><input type="TEXT" name="SHIPADDR2" size=40></td></tr>
  15. <tr><th>City</th><td><input type="TEXT" name="SHIPCITY" size=40></td></tr>
  16. <tr><th>State/Province</th><td><input type="TEXT" name="SHIPSTATE" size=40></td></tr>
  17. <tr><th>ZIP/Mail Code</th><td><input type="TEXT" name="SHIPZIP" size=40 ></td></tr>
  18. <tr><th>Country</th><td><input type="TEXT" name="SHIPCOUNTRY" size=40 ></td></tr>
  19. </table>
  20.  
  21. <br><B>Billing information</B> (Leave empty if same as shipping)<br>
  22. <table border>
  23. <tr><th>Name</th><td><input type="TEXT" name="BILLNAME" size=40></td></tr>
  24. <tr><th>Title</th><td><input type="TEXT" name="BILLTITLE" size=40></td></tr>
  25. <tr><th>Company</th><td><input type="TEXT" name="BILLCOMPANY" size=40></td></tr>
  26. <tr><th>Address 1</th><td><input type="TEXT" name="BILLADDR1" size=40></td></tr>
  27. <tr><th>Address 2</th><td><input type="TEXT" name="BILLADDR2" size=40></td></tr>
  28. <tr><th>City</th><td><input type="TEXT" name="BILLCITY" size=40></td></tr>
  29. <tr><th>State/Province</th><td><input type="TEXT" name="BILLSTATE" size=40></td></tr>
  30. <tr><th>ZIP/Mail Code</th><td><input type="TEXT" name="BILLZIP" size=40></td></tr>
  31. <tr><th>Country</th><td><input type="TEXT" name="BILLCOUNTRY" size=40 ></td></tr>
  32. </table>
  33.  
  34. <br><B>Contact information</B> 
  35. <table border>
  36. <tr><th>Phone</th><td><input type="TEXT" name="PHONE" size=40></td></tr>
  37. <tr><th>Fax</th><td><input type="TEXT" name="FAX" size=40></td></tr>
  38. <tr><th>EMail 1</th><td><input type="TEXT" name="EMAIL1" size=40></td></tr>
  39. <tr><th>EMail 2</th><td><input type="TEXT" name="EMAIL2" size=40></td></tr>
  40. </table>
  41.  
  42.