<?php

?>
<div class="form-title"><img src="/gui/title-persinfo.gif" alt="Personal Information" /></div>

<div class="form-row">
	<label for="salutation">Salutation:</label>
	<select name="salutation" id="f-salutation" value="" class="form-text"><option value="0"></option></select>
	<div class="validation" id="v-salutation"></div>
</div>
<div class="form-row">
	<label for="fname">First Name:</label>
	<input type="text" name="fname" id="f-fname" value="" class="form-text">
	<div class="validation" id="v-fname"></div>
</div>
<div class="form-row">
	<label for="mi">Middle Initail:</label>
	<input type="text" name="mi" id="f-mi" value="" class="form-text">
	<div class="validation" id="v-mi"></div>
</div>
<div class="form-row">
	<label for="lname">Last Name:</label>
	<input type="text" name="lname" id="f-lname" value="" class="form-text">
	<div class="validation" id="v-lname"></div>
</div>

<div class="form-row">
	<label for="add1">Address 1:</label>
	<input type="text" name="add1" id="f-add1" value="" class="form-text">
	<div class="validation" id="v-add1"></div>
</div>
<div class="form-row">
	<label for="add2">Address 2:</label>
	<input type="text" name="add2" id="f-add2" value="" class="form-text">
	<div class="validation" id="v-add2"></div>
</div>
<div class="form-row">
	<label for="city">City:</label>
	<input type="text" name="city" id="f-city" value="" class="form-text">
	<div class="validation" id="v-city"></div>
</div>
<div class="form-row">
	<label for="state">State:</label>
	<select name="state" id="f-state" value="" class="form-text"><option value="0"></option></select>
	<div class="validation" id="v-state"></div>
</div>
<div class="form-row">
	<label for="zip">Postal Code:</label>
	<input type="text" name="zip" id="f-zip" value="" class="form-text">
	<div class="validation" id="v-zip"></div>
</div>

<div class="form-row">
	<label for="phone_home">Home Phone:</label>
	<input type="text" name="phone_home" id="f-phone_home" value="" class="form-text">
	<div class="validation" id="v-phone_home"></div>
</div>
<div class="form-row">
	<label for="phone_mobile">Mobile Phone:</label>
	<input type="text" name="phone_mobile" id="f-phone_mobile" value="" class="form-text">
	<div class="validation" id="v-phone_mobile"></div>
</div>
<div class="form-row">
	<label for="phone_work">Work Phone:</label>
	<input type="text" name="phone_work" id="f-phone_work" value="" class="form-text">
	<div class="validation" id="v-phone_work"></div>
</div>