<script type="text/javascript">
<!--
function form_refresh(F){
 if (F.id.value>""){
    F.AddNew.value="1";
 }
 F.SaveRec.value="";
 F.is_refresh.value="1";
 F.submit();
}

//-->
</script>

<~/common/form_msg>

<table class="form">
<form action="<~./script_name>" method="post" name="DataF" enctype="multipart/form-data">
<input type="hidden" name="SaveRec" value="1">
<input type="hidden" name="AddNew" value="">
<input type="hidden" name="is_refresh" value="">
<input type="hidden" name="id" value="<~c_id>">

<tr>
<td class="label"><~./screen_name> `ID`:</td>
<td class="content"><~c_id>&nbsp;</td>
</tr>

<tr>
<td class="label"><~/common/req>`Name`:</td>
<td class="content"><input type="text" name="item[iname]" size="32" maxlength="64" value="<~iname>" class="text" onChange="input_changed()"></td>
</tr>
<tr>
<td class="label"><~/common/req>`Email`:</td>
<td class="content"><input type="text" name="item[email]" size="64" maxlength="128" value="<~email>" class="text" onChange="input_changed()"></td>
</tr>
<tr valign=top>
<td class="label">`Description`:</td>
<td class="content"><textarea name="item[idesc]" rows="5" cols="50" class="text" onChange="input_changed()"><~idesc></textarea>
</td>
</tr>


<tr valign="top">
<td class="label">`Address`:</td>
<td class="content">
<input type="text" name="item[address1]" size="32" maxlength="64" value="<~address1>" class="text" onChange="input_changed()"><br />
<input type="text" name="item[address2]" size="32" maxlength="64" value="<~address2>" class="text" onChange="input_changed()"><br />
<input type="text" name="item[address3]" size="32" maxlength="64" value="<~address3>" class="text" onChange="input_changed()"><br />
</td>
</tr>
<tr>
<td class="label">`City`:</td>
<td class="content"><input type="text" name="item[city]" size="20" maxlength="64" value="<~city>" class="text" onChange="input_changed()"></td>
</tr>
<tr>
<td class="label">`State`:</td>
<td class="content"><input type="text" name="item[state]" size="16" maxlength="64" value="<~state>" class="text" onChange="input_changed()"></td>
</tr>
<tr>
<td class="label">`Zip`:</td>
<td class="content"><input type="text" name="item[zip]" size="8" maxlength="16" value="<~zip>" class="text" onChange="input_changed()"></td>
</tr>
<tr>
<td class="label">`Country`:</td>
<td class="content">
<select name="item[country]" class="text" onChange="input_changed()">
<option value=""> - `select` - 
<~/common/sel/country.sel select="country">
</select>
</td>
</tr>

<tr>
<td class="label">`Phone` 1:</td>
<td class="content"><input type="text" name="item[work_phone]" size="16" maxlength="16" value="<~work_phone>" class="text" onChange="input_changed()"></td>
</tr>
<tr>
<td class="label">`Phone` 2:</td>
<td class="content"><input type="text" name="item[work_phone2]" size="16" maxlength="16" value="<~work_phone2>" class="text" onChange="input_changed()"></td>
</tr>

<!--tr valign=top>
<td class="label">Upload customer image:</td>
<td class="content"><input type="file" name="file1" size="32" value="" class="text" onChange="input_changed()">
<br>
<~showimg ifneq="upload_url" value="" inline>
<table><tr><td class="content">
<a href="<~upload_url>?<~rand_str>" target="_blank"><img src="<~upload_url_preview>?<~rand_str>" width="100" border="0" class="bordered"></a>
</td><td class="content">
`click on it for full review`<br>
<a href="#" onClick="return delete_btn('<~script_name>?DelImg=1&id=<~c_id>')">`Delete image`</a>
</tr></table>
</~showimg>
</td>
</tr-->

<tr>
<td class="label">`Status`:</td>
<td class="content"><input type="checkbox" name="item[status]" value="127" <~/common/checked ifeq="status" value="127">> deleted?</td>
</tr>
<tr>
<td class="label">`Added on`:</td>
<td class="content"><~add_time> by <~add_u_id_name></td>
</tr>
<tr>
<td class="label">`Updated on`:</td>
<td class="content"><~upd_time> <~upd_u_id_name_block ifge="upd_u_id" value="0" inline>by <~upd_u_id_name></~upd_u_id_name_block></td>
</tr>

<tr>
<td colspan="2" class="label">

<~/common/req_msg>
<input type="submit" value=" <~str_update ifneq="c_id" value="0" inline>`Update`</~str_update><~str_insert ifeq="c_id" value="0" inline>`Insert`</~str_insert> ">&nbsp;
<input type="submit" name="AndAddNext" value=" <~str_update ifneq="c_id" value="0" inline>`Update`</~str_update><~str_insert ifeq="c_id" value="0" inline>`Insert`</~str_insert> `and Add New` <~../screen_name>">&nbsp;
<input type="button" value=" `Cancel` " onClick="cancel_form('<~../script_name>')">

</td>
</tr>
</form>
</table>
<br>