{include file="$config_style/header.html"}
           
  <TD vAlign=top>
      	<TABLE id=table171 width="100%" border=0>
        <TBODY>
        <TR>
          <TD width="100%" align="right">




	<table  width="100%" >
    <TR>
                      <TD align=middle width="74%" bgColor=#105184 height=25>
                        <P align=left>&nbsp;<B><FONT face=Verdana color=#ffffff
                        size=2>&gt;
             {$mytitle}</FONT></B></P></TD></TR>
        <tr >
{if ($erro_insert_all_filds2 or $dubl or $success6 or $Erro_Formula_Email or $card or $num1 or $mob1)}
<td class="value">{$erro_insert_all_filds2} {$dubl} {$success6} {$Erro_Formula_Email}{$card} {$num1} {$mob1}
</td>{/if}
</tr>
		<tr>

              <TD vAlign=top>
			   <form method="post" enctype="multipart/form-data">
      <TABLE id=table242 width="100%">
        <TBODY>
        
        <TR>
          <TD>
            <TABLE id=table259 width="100%">
              
              <TBODY>
              <tr>
                <TD align=middle width="13%" bgColor=#105184><FONT 
                  face=Verdana color=#ffffff size=1><B>Status</B></FONT></TD>
                <TD><SELECT name=status> <OPTION value=1 
                    selected>Active</OPTION> <OPTION 
                  value=0>Inactive</OPTION></SELECT></TD>
              </tr>
				</TBODY></TABLE>
            </TD></TR></TBODY></TABLE>
            <TABLE id=table260 width="100%" border=0>
              <TBODY>
              <TR>
                <TD vAlign=top align="center">
                  <TABLE id=table261>
                    <TBODY>
                    <TR>
                      <TD align=middle>
						<img border="0" src="image%20engine/nnophoto.gif" width="80" height="80"> 
                  </TD></TR></TBODY></TABLE></TD>
                <TD>
                  <TABLE id=table262 width="100%">
                    <TBODY>
					<TR>
                      <TD align=middle width="18%" bgColor=#105184><FONT 
                        face=Verdana color=#ffffff size=1><SPAN 
                        class=req>*</SPAN>&nbsp;<B>Card ID</B></FONT></TD>
                      <TD><INPUT size=38 name=card_id style="background-color: #FFFF00" value="{$smarty.post.card_id}"> </TD></TR>
					  <tr>
                      <TD align=middle width="18%" bgColor=#105184>
						<span lang="en-us"><font color="#FFFFFF"><SPAN 
                        class=req>*</SPAN>&nbsp;<b>Merchant</b></font></span></TD>
						<TD>
						<SELECT name=brand>
						<OPTION value="" {if $smarty.post.brand eq "0"}SELECTED{/if}>
						Select
						</OPTION>
						{foreach  item=rep from=$rep}
						<OPTION value={$rep.name} {if $smarty.post.brand eq $rep.name}SELECTED{/if}>
						{$rep.name}
						</OPTION>
						{/foreach}
						</SELECT>
						</TD>
					</tr>
<tr>
                      <TD bgColor=#e6e6e6 colSpan=2>
						<font face="Verdana" color="#000000" size="1"><b>
						Customer Profile</b></font></TD>
					</tr>

                    <TR>
                      <TD align=middle width="18%" bgColor=#105184>
						<span lang="en-us"><font color="#FFFFFF"><b>Picture</b></font></span></TD>
                      <TD><INPUT type=file size=38 name=pic>
					 
					  &nbsp;JPG or 
                        GIF file (File size limit is 1 MB)  </TD></TR>
                    <tr>
                      <TD align=middle width="18%" bgColor=#105184>
						<FONT 
                        face=Verdana color=#ffffff size=1><B><span lang="en-us">Username</span></B></FONT></TD>
                      <TD><INPUT size=38 name=username value="{$smarty.post.username}"> </TD>
					</tr>
					<tr>
                      <TD align=middle width="18%" bgColor=#105184>
						<FONT 
                        face=Verdana color=#ffffff size=1><span lang="en-us"><b>Password</b></span></FONT></TD>
                      <TD><INPUT size=38 name=pass value="{$smarty.post.pass}"> </TD>
					</tr>
                    <TR>
                      <TD bgColor=#e6e6e6 colSpan=2><SPAN 
                        lang=en-us><B>Contact</B></SPAN><FONT face=Verdana 
                        color=#000000 size=1><B> Information</B></FONT> </TD></TR>
                    <TR>
                      <TD align=middle width="18%" bgColor=#105184><FONT 
                        face=Verdana color=#ffffff size=1><B>Title</B></FONT></TD>
                      <TD><Select name="title">
                    <option value="">{$smarty.const.Select}</option>
                    <option value="Mr"   {if $smarty.post.title eq "Mr"}SELECTED{/if}>Mr</option>
                    <option value="Ms."   {if $smarty.post.title eq "Ms."}SELECTED{/if}>Ms.</option>
                    <option value="Miss" {if $smarty.post.title eq "Miss"}SELECTED{/if}>Miss</option>
                    <option value="Mrs"  {if $smarty.post.title eq "Mrs"}SELECTED{/if}>Mrs</option>
                    <option value="Eng."  {if $smarty.post.title eq "Eng."}SELECTED{/if}>Eng.</option>
                    <option value="Dr."  {if $smarty.post.title eq "Dr."}SELECTED{/if}>Dr.</option>
                    <option value="Prof."  {if $smarty.post.title eq "Prof."}SELECTED{/if}>Prof.</option>  </Select> </TD></TR>
                    <TR>
                      <TD align=middle width="18%" bgColor=#105184><FONT 
                        face=Verdana color=#ffffff size=1><SPAN 
                        class=req>*</SPAN>&nbsp;<B>First 
                        name</B></FONT></TD>
                      <TD><INPUT size=38 name=first_name value="{$smarty.post.first_name}"> </TD></TR>
                    <TR>
                      <TD align=middle width="18%" bgColor=#105184><FONT 
                        face=Verdana color=#ffffff size=1><B>Middle 
                        name</B></FONT></TD>
                      <TD><INPUT size=38 name=middle_name value="{$smarty.post.middle_name}"> </TD></TR>
                    <TR>
                      <TD align=middle width="18%" bgColor=#105184><FONT 
                        face=Verdana color=#ffffff size=1><SPAN 
                        class=req>*</SPAN>&nbsp;<B>Last 
                      name</B></FONT></TD>
                      <TD><INPUT size=38 name=last_name value="{$smarty.post.last_name}"> </TD></TR>
                    <TR>
                      <TD align=middle width="18%" bgColor=#105184><FONT 
                        face=Verdana color=#ffffff size=1><B>Job 
                      title</B></FONT></TD>
                      <TD><SELECT name=jop> <OPTION value="" 
                          selected>Select</OPTION> <OPTION 
                          value=Advisor/Consultant {if $smarty.post.jop eq "Advisor/Consultant"}SELECTED{/if}>Advisor/Consultant</OPTION> 
                          <OPTION value="Applications Specialist" {if $smarty.post.jop eq "Applications Specialist"}SELECTED{/if}>Applications 
                          Specialist</OPTION> <OPTION 
                          value="Assistant Office Manager" {if $smarty.post.jop eq "Assistant Office Manager"}SELECTED{/if}>Assistant Office 
                          Manager</OPTION> <OPTION 
                          value="Business Development" {if $smarty.post.jop eq "Business Development"}SELECTED{/if}>Business 
                          Development</OPTION> <OPTION value="CCO, CMO" {if $smarty.post.jop eq "CCO, CMO"}SELECTED{/if}>CCO, 
                          CMO</OPTION> <OPTION 
                          value="CEO, COO, Owner, Partner" {if $smarty.post.jop eq "CEO, COO, Owner, Partner"}SELECTED{/if}>CEO, COO, Owner, 
                          Partner</OPTION> <OPTION 
                          value=CFO/Treasurer/Controller {if $smarty.post.jop eq "CFO/Treasurer/Controller"}SELECTED{/if}>CFO/Treasurer/Controller</OPTION> 
                          <OPTION value=CSO {if $smarty.post.jop eq "CSO"}SELECTED{/if}>CSO</OPTION> <OPTION 
                          value="CTO, CIO" {if $smarty.post.jop eq "CTO, CIO"}SELECTED{/if}>CTO, CIO</OPTION> <OPTION 
                          value=Designer/Illustrator>Designer/Illustrator</OPTION> 
                          <OPTION value="Director of Communication" {if $smarty.post.jop eq "Director of Communication"}SELECTED{/if}>Director of 
                          Communication</OPTION> <OPTION 
                          value="Director of Finance" {if $smarty.post.jop eq "Director of Finance"}SELECTED{/if}>Director of 
                          Finance</OPTION> <OPTION 
                          value="Director of IS/MIS/IT" {if $smarty.post.jop eq "Director of IS/MIS/IT"}SELECTED{/if}>Director of 
                          IS/MIS/IT</OPTION> <OPTION 
                          value="Director of Manufacturing" {if $smarty.post.jop eq "Director of Manufacturing"}SELECTED{/if}>Director of 
                          Manufacturing</OPTION> <OPTION 
                          value="Director of Networking" {if $smarty.post.jop eq "Director of Networking"}SELECTED{/if}>Director of 
                          Networking</OPTION> <OPTION 
                          value="Director of Operations" {if $smarty.post.jop eq "Director of Operations"}SELECTED{/if}>Director of 
                          Operations</OPTION> <OPTION 
                          value="Director of Sales/Marketing" {if $smarty.post.jop eq "Director of Sales/Marketing"}SELECTED{/if}>Director of 
                          Sales/Marketing</OPTION> <OPTION 
                          value="Director, Senior Management" {if $smarty.post.jop eq "Director, Senior Management"}SELECTED{/if}>Director, Senior 
                          Management</OPTION> <OPTION 
                          value="Editor, Writer, Journalist" {if $smarty.post.jop eq "Editor, Writer, Journalist"}SELECTED{/if}>Editor, Writer, 
                          Journalist</OPTION> <OPTION 
                          value=EVP/SVP/VP {if $smarty.post.jop eq "EVP/SVP/VP"}SELECTED{/if}>EVP/SVP/VP</OPTION> <OPTION 
                          value="EVP/SVP/VP of Communication" {if $smarty.post.jop eq "EVP/SVP/VP of Communication"}SELECTED{/if}>EVP/SVP/VP of 
                          Communication</OPTION> <OPTION 
                          value="EVP/SVP/VP of Engineering" {if $smarty.post.jop eq "EVP/SVP/VP of Engineering"}SELECTED{/if}>EVP/SVP/VP of 
                          Engineering</OPTION> <OPTION 
                          value="EVP/SVP/VP of Finance" {if $smarty.post.jop eq "EVP/SVP/VP of Finance"}SELECTED{/if}>EVP/SVP/VP of 
                          Finance</OPTION> <OPTION 
                          value="EVP/SVP/VP of IS/MIS/IT" {if $smarty.post.jop eq "EVP/SVP/VP of IS/MIS/IT"}SELECTED{/if}>EVP/SVP/VP of 
                          IS/MIS/IT</OPTION> <OPTION 
                          value="EVP/SVP/VP of Manufacturing" {if $smarty.post.jop eq "EVP/SVP/VP of Manufacturing"}SELECTED{/if}>EVP/SVP/VP of 
                          Manufacturing</OPTION> <OPTION 
                          value="EVP/SVP/VP of Networking" {if $smarty.post.jop eq "EVP/SVP/VP of Networking"}SELECTED{/if}>EVP/SVP/VP of 
                          Networking</OPTION> <OPTION 
                          value="EVP/SVP/VP of Operations" {if $smarty.post.jop eq "EVP/SVP/VP of Operations"}SELECTED{/if}>EVP/SVP/VP of 
                          Operations</OPTION> <OPTION 
                          value="EVP/SVP/VP of Sales/Marketing" {if $smarty.post.jop eq "EVP/SVP/VP of Sales/Marketing"}SELECTED{/if}>EVP/SVP/VP of 
                          Sales/Marketing</OPTION> <OPTION 
                          value="Executive Sales Representative" {if $smarty.post.jop eq "Executive Sales Representative"}SELECTED{/if}>Executive Sales 
                          Representative</OPTION> <OPTION 
                          value="Executive Secretary" {if $smarty.post.jop eq "Executive Secretary"}SELECTED{/if}>Executive 
                          Secretary</OPTION> <OPTION value=HR>HR</OPTION> 
                          <OPTION 
                          value=Minster/Ambassador {if $smarty.post.jop eq "Minster/Ambassador"}SELECTED{/if}>Minster/Ambassador</OPTION> 
                          <OPTION value="Office Manager" {if $smarty.post.jop eq "Office Manager"}SELECTED{/if}>Office Manager</OPTION> 
                          <OPTION value="Pre-Sales Director" {if $smarty.post.jop eq "Pre-Sales Director"}SELECTED{/if}>Pre-Sales 
                          Director</OPTION> <OPTION 
                          value=Purchase {if $smarty.post.jop eq "Purchase"}SELECTED{/if}>Purchase</OPTION> <OPTION 
                          value=Regulator {if $smarty.post.jop eq "Regulator"}SELECTED{/if}>Regulator</OPTION> <OPTION 
                          value="Sales/Marketing Coordinator" {if $smarty.post.jop eq "Sales/Marketing Coordinator"}SELECTED{/if}>Sales/Marketing 
                          Coordinator</OPTION> <OPTION 
                          value="Senior IT Management" {if $smarty.post.jop eq "Senior IT Management"}SELECTED{/if}>Senior IT 
                          Management</OPTION> <OPTION 
                          value=Student {if $smarty.post.jop eq "Student"}SELECTED{/if}>Student</OPTION> <OPTION 
                          value=Support {if $smarty.post.jop eq "Support"}SELECTED{/if}>Support</OPTION></SELECT> </TD></TR>
                    <TR>
                      <TD align=middle width="18%" bgColor=#105184>
						<FONT 
                        face=Verdana color=#ffffff size=1><B>Email</B></FONT></TD>
                      <TD><INPUT size=38 name=email value="{$smarty.post.email}"> </TD></TR>
                    <TR>
                      <TD align=middle width="18%" bgColor=#105184><FONT 
                        face=Verdana color=#ffffff size=1><B>Another 
                        email</B></FONT></TD>
                      <TD><INPUT size=38 name=another_email value="{$smarty.post.another_email}"> </TD></TR>
                    <TR>
                      <TD align=middle width="18%" bgColor=#105184><FONT 
                        face=Verdana color=#ffffff size=1><B>Company 
                        URL</B></FONT></TD>
                      <TD><INPUT size=38 name=url value="{$smarty.post.url}"> </TD></TR>
                    <TR>
                      <TD align=middle width="18%" bgColor=#105184><FONT 
                        face=Verdana color=#ffffff size=1><B>Telephone 
                        1</B></FONT></TD>
                      <TD>
                        <TABLE id=table263>
                          <TBODY>
                          <TR>
                            <TD><INPUT size=28 name=tel1 value="{$smarty.post.tel1}"> </TD>
                            <TD align=middle width="18%" bgColor=#105184><FONT 
                              face=Verdana color=#ffffff size=1><B>Ext. 
                              1</B></FONT></TD>
                            <TD><INPUT size=10 name=ext1 value="{$smarty.post.ext1}"> 
                      </TD></TR></TBODY></TABLE></TD></TR>
                    <TR>
                      <TD align=middle width="18%" bgColor=#105184><FONT 
                        face=Verdana color=#ffffff size=1><B>Telephone 
                        2</B></FONT></TD>
                      <TD>
                        <TABLE id=table264>
                          <TBODY>
                          <TR>
                            <TD><INPUT size=28 name=tel2 value="{$smarty.post.tel2}"> </TD>
                            <TD align=middle width="18%" bgColor=#105184><FONT 
                              face=Verdana color=#ffffff size=1><B>Ext. 
                              2</B></FONT></TD>
                            <TD><INPUT size=10 name=ext2 value="{$smarty.post.ext2}"> 
                      </TD></TR></TBODY></TABLE></TD></TR>
                    <TR>
                      <TD align=middle width="18%" bgColor=#105184><FONT 
                        face=Verdana color=#ffffff size=1><B>Telephone 
                        3</B></FONT></TD>
                      <TD>
                        <TABLE id=table265>
                          <TBODY>
                          <TR>
                            <TD><INPUT size=28 name=tel3 value="{$smarty.post.tel3}"> </TD>
                            <TD align=middle width="18%" bgColor=#105184><FONT 
                              face=Verdana color=#ffffff size=1><B>Ext. 
                              3</B></FONT></TD>
                            <TD><INPUT size=10 name=ext3 value="{$smarty.post.ext3}"> 
                      </TD></TR></TBODY></TABLE></TD></TR>
                    <TR>
                      <TD align=middle width="18%" bgColor=#105184><FONT 
                        face=Verdana color=#ffffff size=1><B>Telephone 
                        4</B></FONT></TD>
                      <TD>
                        <TABLE id=table266>
                          <TBODY>
                          <TR>
                            <TD><INPUT size=28 name=tel4 value="{$smarty.post.tel4}"> </TD>
                            <TD align=middle width="18%" bgColor=#105184><FONT 
                              face=Verdana color=#ffffff size=1><B>Ext. 
                              4</B></FONT></TD>
                            <TD><INPUT size=10 name=ext4 value="{$smarty.post.ext4}"> 
                      </TD></TR></TBODY></TABLE></TD></TR>
                    <TR>
                      <TD align=middle width="18%" bgColor=#105184><FONT 
                        face=Verdana color=#ffffff size=1><B>Fax 
                        Number</B></FONT></TD>
                      <TD>
                        <TABLE id=table267 width=371>
                          <TBODY>
                          <TR>
                            <TD width=148><INPUT size=28 name=fax value="{$smarty.post.fax}"> </TD>
                            <TD align=middle width="18%" bgColor=#105184><FONT 
                              face=Verdana color=#ffffff size=1><B>Fax 
                              Ext.</B></FONT></TD>
                            <TD><INPUT size=10 name=extfax value="{$smarty.post.extfax}"> 
                      </TD></TR></TBODY></TABLE></TD></TR>
                    <TR>
                      <TD align=middle width="18%" bgColor=#105184><FONT 
                        face=Verdana color=#ffffff size=1><B>Mobile 
                      1</B></FONT></TD>
                      <TD><INPUT size=38 name=mob1 value="{$smarty.post.mob1}"> </TD></TR>
                    <TR>
                      <TD align=middle width="18%" bgColor=#105184><FONT 
                        face=Verdana color=#ffffff size=1><B>Mobile 
                      2</B></FONT></TD>
                      <TD><INPUT size=38 name=mob2 value="{$smarty.post.mob2}"> </TD></TR>
                    <TR>
                      <TD align=middle width="18%" bgColor=#105184><FONT 
                        face=Verdana color=#ffffff size=1><B>Home 
                        Phone</B></FONT></TD>
                      <TD><INPUT size=38 name=home_phone value="{$smarty.post.home_phone}"> </TD></TR>
                    <TR>
                      <TD align=middle width="18%" bgColor=#105184><FONT 
                        face=Verdana color=#ffffff 
                      size=1><B>Country</B></FONT></TD>
                      <TD><SELECT name=country> <OPTION value="" 
                          selected>Select</OPTION> <OPTION 
                          value=Afghanistan {if $smarty.post.country eq "Afghanistan"}SELECTED{/if}>Afghanistan</OPTION> <OPTION 
                          value=Albania {if $smarty.post.country eq "Albania"}SELECTED{/if}>Albania</OPTION> <OPTION 
                          value=Algeria {if $smarty.post.country eq "Algeria"}SELECTED{/if}>Algeria</OPTION> <OPTION 
                          value="American Samoa">American Samoa</OPTION> <OPTION 
                          value=Andorra>Andorra</OPTION> <OPTION 
                          value=Angola>Angola</OPTION> <OPTION 
                          value=Anguilla>Anguilla</OPTION> <OPTION 
                          value=Antarctica>Antarctica</OPTION> <OPTION 
                          value="Antigua and Barbuda">Antigua and 
                          Barbuda</OPTION> <OPTION 
                          value=Argentina>Argentina</OPTION> <OPTION 
                          value=Armenia>Armenia</OPTION> <OPTION 
                          value=Aruba>Aruba</OPTION> <OPTION 
                          value=Australia>Australia</OPTION> <OPTION 
                          value=Austria>Austria</OPTION> <OPTION 
                          value=Azerbaijan>Azerbaijan</OPTION> <OPTION 
                          value=Bahamas>Bahamas</OPTION> <OPTION 
                          value=Bahrain>Bahrain</OPTION> <OPTION 
                          value=Bangladesh>Bangladesh</OPTION> <OPTION 
                          value=Barbados>Barbados</OPTION> <OPTION 
                          value=Belarus>Belarus</OPTION> <OPTION 
                          value=Belgium>Belgium</OPTION> <OPTION 
                          value=Belize>Belize</OPTION> <OPTION 
                          value=Benin>Benin</OPTION> <OPTION 
                          value=Bermuda>Bermuda</OPTION> <OPTION 
                          value=Bhutan>Bhutan</OPTION> <OPTION 
                          value=Bolivia>Bolivia</OPTION> <OPTION 
                          value="Bosnia and Herzegovina">Bosnia and 
                          Herzegovina</OPTION> <OPTION 
                          value=Botswana>Botswana</OPTION> <OPTION 
                          value="Bouvet Island">Bouvet Island</OPTION> <OPTION 
                          value=Brazil>Brazil</OPTION> <OPTION 
                          value="British Indian Ocean Territory">British Indian 
                          Ocean Territory</OPTION> <OPTION 
                          value=Brunei>Brunei</OPTION> <OPTION 
                          value=Bulgaria>Bulgaria</OPTION> <OPTION 
                          value="Burkina Faso">Burkina Faso</OPTION> <OPTION 
                          value=Burundi>Burundi</OPTION> <OPTION 
                          value=Cambodia>Cambodia</OPTION> <OPTION 
                          value=Cameroon>Cameroon</OPTION> <OPTION 
                          value=Canada>Canada</OPTION> <OPTION 
                          value="Cape Verde">Cape Verde</OPTION> <OPTION 
                          value="Cayman Islands">Cayman Islands</OPTION> <OPTION 
                          value="Central African Republic">Central African 
                          Republic</OPTION> <OPTION value=Chad>Chad</OPTION> 
                          <OPTION value=Chile>Chile</OPTION> <OPTION 
                          value=China>China</OPTION> <OPTION 
                          value="Christmas Island">Christmas Island</OPTION> 
                          <OPTION value="Cocos (Keeling) Islands">Cocos 
                          (Keeling) Islands</OPTION> <OPTION 
                          value=Colombia>Colombia</OPTION> <OPTION 
                          value=Comoros>Comoros</OPTION> <OPTION 
                          value=Congo>Congo</OPTION> <OPTION 
                          value="Congo, The Democratic Republic of the">Congo, 
                          The Democratic Republic of the</OPTION> <OPTION 
                          value="Cook Islands">Cook Islands</OPTION> <OPTION 
                          value="Costa Rica">Costa Rica</OPTION> <OPTION 
                          value="Côte d’Ivoire">Côte d’Ivoire</OPTION> <OPTION 
                          value=Croatia>Croatia</OPTION> <OPTION 
                          value=Cuba>Cuba</OPTION> <OPTION 
                          value=Cyprus>Cyprus</OPTION> <OPTION 
                          value="Czech Republic">Czech Republic</OPTION> <OPTION 
                          value=Denmark>Denmark</OPTION> <OPTION 
                          value=Djibouti>Djibouti</OPTION> <OPTION 
                          value=Dominica>Dominica</OPTION> <OPTION 
                          value="Dominican Republic">Dominican Republic</OPTION> 
                          <OPTION value="East Timor">East Timor</OPTION> <OPTION 
                          value=Ecuador {if $smarty.post.country eq "Ecuador"}SELECTED{/if}>Ecuador</OPTION> <OPTION 
                          value=Egypt {if $smarty.post.country eq "Egypt"}SELECTED{/if}>Egypt</OPTION> <OPTION 
                          value="El Salvador" {if $smarty.post.country eq "El Salvador"}SELECTED{/if}>El Salvador</OPTION> <OPTION 
                          value="Equatorial Guinea">Equatorial Guinea</OPTION> 
                          <OPTION value=Eritrea>Eritrea</OPTION> <OPTION 
                          value=Estonia>Estonia</OPTION> <OPTION 
                          value=Ethiopia>Ethiopia</OPTION> <OPTION 
                          value="Falkland Islands">Falkland Islands</OPTION> 
                          <OPTION value="Faroe Islands">Faroe Islands</OPTION> 
                          <OPTION value="Fiji Islands">Fiji Islands</OPTION> 
                          <OPTION value=Finland>Finland</OPTION> <OPTION 
                          value=France>France</OPTION> <OPTION 
                          value="French Guiana">French Guiana</OPTION> <OPTION 
                          value="French Polynesia">French Polynesia</OPTION> 
                          <OPTION value="French Southern territories">French 
                          Southern territories</OPTION> <OPTION 
                          value=Gabon>Gabon</OPTION> <OPTION 
                          value=Gambia>Gambia</OPTION> <OPTION 
                          value=Georgia>Georgia</OPTION> <OPTION 
                          value=Germany>Germany</OPTION> <OPTION 
                          value=Ghana>Ghana</OPTION> <OPTION 
                          value=Gibraltar>Gibraltar</OPTION> <OPTION 
                          value=Greece>Greece</OPTION> <OPTION 
                          value=Greenland>Greenland</OPTION> <OPTION 
                          value=Grenada>Grenada</OPTION> <OPTION 
                          value=Guadeloupe>Guadeloupe</OPTION> <OPTION 
                          value=Guam>Guam</OPTION> <OPTION 
                          value=Guatemala>Guatemala</OPTION> <OPTION 
                          value=Guinea>Guinea</OPTION> <OPTION 
                          value=Guinea-Bissau>Guinea-Bissau</OPTION> <OPTION 
                          value=Guyana>Guyana</OPTION> <OPTION 
                          value=Haiti>Haiti</OPTION> <OPTION 
                          value="Heard Island and McDonald Islands">Heard Island 
                          and McDonald Islands</OPTION> <OPTION 
                          value="Holy See (Vatican City State)">Holy See 
                          (Vatican City State)</OPTION> <OPTION 
                          value=Honduras>Honduras</OPTION> <OPTION 
                          value="Hong Kong">Hong Kong</OPTION> <OPTION 
                          value=Hungary>Hungary</OPTION> <OPTION 
                          value=Iceland>Iceland</OPTION> <OPTION 
                          value=India>India</OPTION> <OPTION 
                          value=Indonesia>Indonesia</OPTION> <OPTION 
                          value=Iran>Iran</OPTION> <OPTION 
                          value=Iraq>Iraq</OPTION> <OPTION 
                          value=Ireland>Ireland</OPTION> <OPTION 
                          value=Israel>Israel</OPTION> <OPTION 
                          value=Italy>Italy</OPTION> <OPTION 
                          value=Jamaica>Jamaica</OPTION> <OPTION 
                          value=Japan>Japan</OPTION> <OPTION 
                          value=Jordan>Jordan</OPTION> <OPTION 
                          value=Kazakstan>Kazakstan</OPTION> <OPTION 
                          value=Kenya>Kenya</OPTION> <OPTION 
                          value=Kiribati>Kiribati</OPTION> <OPTION 
                          value=Kuwait>Kuwait</OPTION> <OPTION 
                          value=Kyrgyzstan>Kyrgyzstan</OPTION> <OPTION 
                          value=Laos>Laos</OPTION> <OPTION 
                          value=Latvia>Latvia</OPTION> <OPTION 
                          value=Lebanon>Lebanon</OPTION> <OPTION 
                          value=Lesotho>Lesotho</OPTION> <OPTION 
                          value=Liberia>Liberia</OPTION> <OPTION 
                          value="Libyan Arab Jamahiriya">Libyan Arab 
                          Jamahiriya</OPTION> <OPTION 
                          value=Liechtenstein>Liechtenstein</OPTION> <OPTION 
                          value=Lithuania>Lithuania</OPTION> <OPTION 
                          value=Luxembourg>Luxembourg</OPTION> <OPTION 
                          value=Macao>Macao</OPTION> <OPTION 
                          value=Macedonia>Macedonia</OPTION> <OPTION 
                          value=Madagascar>Madagascar</OPTION> <OPTION 
                          value=Malawi>Malawi</OPTION> <OPTION 
                          value=Malaysia>Malaysia</OPTION> <OPTION 
                          value=Maldives>Maldives</OPTION> <OPTION 
                          value=Mali>Mali</OPTION> <OPTION 
                          value=Malta>Malta</OPTION> <OPTION 
                          value="Marshall Islands">Marshall Islands</OPTION> 
                          <OPTION value=Martinique>Martinique</OPTION> <OPTION 
                          value=Mauritania>Mauritania</OPTION> <OPTION 
                          value=Mauritius>Mauritius</OPTION> <OPTION 
                          value=Mayotte>Mayotte</OPTION> <OPTION 
                          value=Mexico>Mexico</OPTION> <OPTION 
                          value="Micronesia, Federated States of">Micronesia, 
                          Federated States of</OPTION> <OPTION 
                          value=Moldova>Moldova</OPTION> <OPTION 
                          value=Monaco>Monaco</OPTION> <OPTION 
                          value=Mongolia>Mongolia</OPTION> <OPTION 
                          value=Montserrat>Montserrat</OPTION> <OPTION 
                          value=Morocco>Morocco</OPTION> <OPTION 
                          value=Mozambique>Mozambique</OPTION> <OPTION 
                          value=Myanmar>Myanmar</OPTION> <OPTION 
                          value=Namibia>Namibia</OPTION> <OPTION 
                          value=Nauru>Nauru</OPTION> <OPTION 
                          value=Nepal>Nepal</OPTION> <OPTION 
                          value=Netherlands>Netherlands</OPTION> <OPTION 
                          value="Netherlands Antilles">Netherlands 
                          Antilles</OPTION> <OPTION value="New Caledonia">New 
                          Caledonia</OPTION> <OPTION value="New Zealand">New 
                          Zealand</OPTION> <OPTION 
                          value=Nicaragua>Nicaragua</OPTION> <OPTION 
                          value=Niger>Niger</OPTION> <OPTION 
                          value=Nigeria>Nigeria</OPTION> <OPTION 
                          value=Niue>Niue</OPTION> <OPTION 
                          value="Norfolk Island">Norfolk Island</OPTION> <OPTION 
                          value="North Korea">North Korea</OPTION> <OPTION 
                          value="Northern Mariana Islands">Northern Mariana 
                          Islands</OPTION> <OPTION value=Norway>Norway</OPTION> 
                          <OPTION value=Oman>Oman</OPTION> <OPTION 
                          value=Pakistan>Pakistan</OPTION> <OPTION 
                          value=Palau>Palau</OPTION> <OPTION 
                          value=Palestine>Palestine</OPTION> <OPTION 
                          value=Panama>Panama</OPTION> <OPTION 
                          value="Papua New Guinea">Papua New Guinea</OPTION> 
                          <OPTION value=Paraguay>Paraguay</OPTION> <OPTION 
                          value=Peru>Peru</OPTION> <OPTION 
                          value=Philippines>Philippines</OPTION> <OPTION 
                          value=Pitcairn>Pitcairn</OPTION> <OPTION 
                          value=Poland>Poland</OPTION> <OPTION 
                          value=Portugal>Portugal</OPTION> <OPTION 
                          value="Puerto Rico">Puerto Rico</OPTION> <OPTION 
                          value=Qatar>Qatar</OPTION> <OPTION 
                          value=Réunion>Réunion</OPTION> <OPTION 
                          value=Romania>Romania</OPTION> <OPTION 
                          value="Russian Federation">Russian Federation</OPTION> 
                          <OPTION value=Rwanda>Rwanda</OPTION> <OPTION 
                          value="Saint Helena">Saint Helena</OPTION> <OPTION 
                          value="Saint Kitts and Nevis">Saint Kitts and 
                          Nevis</OPTION> <OPTION value="Saint Lucia">Saint 
                          Lucia</OPTION> <OPTION 
                          value="Saint Pierre and Miquelon">Saint Pierre and 
                          Miquelon</OPTION> <OPTION 
                          value="Saint Vincent and the Grenadines">Saint Vincent 
                          and the Grenadines</OPTION> <OPTION 
                          value=Samoa>Samoa</OPTION> <OPTION 
                          value="San Marino">San Marino</OPTION> <OPTION 
                          value="Sao Tome and Principe">Sao Tome and 
                          Principe</OPTION> <OPTION value="Saudi Arabia">Saudi 
                          Arabia</OPTION> <OPTION value=Senegal>Senegal</OPTION> 
                          <OPTION value=Seychelles>Seychelles</OPTION> <OPTION 
                          value="Sierra Leone">Sierra Leone</OPTION> <OPTION 
                          value=Singapore>Singapore</OPTION> <OPTION 
                          value=Slovakia>Slovakia</OPTION> <OPTION 
                          value=Slovenia>Slovenia</OPTION> <OPTION 
                          value="Solomon Islands">Solomon Islands</OPTION> 
                          <OPTION value=Somalia>Somalia</OPTION> <OPTION 
                          value="South Africa">South Africa</OPTION> <OPTION 
                          value="South Georgia and the South Sandwich Islands">South 
                          Georgia and the South Sandwich Islands</OPTION> 
                          <OPTION value="South Korea">South Korea</OPTION> 
                          <OPTION value=Spain>Spain</OPTION> <OPTION 
                          value="Sri Lanka">Sri Lanka</OPTION> <OPTION 
                          value=Sudan>Sudan</OPTION> <OPTION 
                          value=Suriname>Suriname</OPTION> <OPTION 
                          value="Svalbard and Jan Mayen">Svalbard and Jan 
                          Mayen</OPTION> <OPTION 
                          value=Swaziland>Swaziland</OPTION> <OPTION 
                          value=Sweden>Sweden</OPTION> <OPTION 
                          value=Switzerland>Switzerland</OPTION> <OPTION 
                          value=Syria>Syria</OPTION> <OPTION 
                          value=Taiwan>Taiwan</OPTION> <OPTION 
                          value=Tajikistan>Tajikistan</OPTION> <OPTION 
                          value=Tanzania>Tanzania</OPTION> <OPTION 
                          value=Thailand>Thailand</OPTION> <OPTION 
                          value=Togo>Togo</OPTION> <OPTION 
                          value=Tokelau>Tokelau</OPTION> <OPTION 
                          value=Tonga>Tonga</OPTION> <OPTION 
                          value="Trinidad and Tobago">Trinidad and 
                          Tobago</OPTION> <OPTION value=Tunisia>Tunisia</OPTION> 
                          <OPTION value=Turkey>Turkey</OPTION> <OPTION 
                          value=Turkmenistan>Turkmenistan</OPTION> <OPTION 
                          value="Turks and Caicos Islands">Turks and Caicos 
                          Islands</OPTION> <OPTION value=Tuvalu>Tuvalu</OPTION> 
                          <OPTION value=Uganda>Uganda</OPTION> <OPTION 
                          value=Ukraine>Ukraine</OPTION> <OPTION 
                          value="United Arab Emirates">United Arab 
                          Emirates</OPTION> <OPTION 
                          value="United Kingdom">United Kingdom</OPTION> <OPTION 
                          value="United States">United States</OPTION> <OPTION 
                          value="United States Minor Outlying Islands">United 
                          States Minor Outlying Islands</OPTION> <OPTION 
                          value=Uruguay>Uruguay</OPTION> <OPTION 
                          value=Uzbekistan>Uzbekistan</OPTION> <OPTION 
                          value=Vanuatu>Vanuatu</OPTION> <OPTION 
                          value=Venezuela>Venezuela</OPTION> <OPTION 
                          value=Vietnam>Vietnam</OPTION> <OPTION 
                          value="Virgin Islands, British">Virgin Islands, 
                          British</OPTION> <OPTION 
                          value="Virgin Islands, U.S.">Virgin Islands, 
                          U.S.</OPTION> <OPTION value="Wallis and Futuna">Wallis 
                          and Futuna</OPTION> <OPTION 
                          value="Western Sahara">Western Sahara</OPTION> <OPTION 
                          value=Yemen>Yemen</OPTION> <OPTION 
                          value=Yugoslavia>Yugoslavia</OPTION> <OPTION 
                          value=Zambia>Zambia</OPTION> <OPTION 
                          value=Zimbabwe>Zimbabwe</OPTION></SELECT> </TD></TR>
                    <TR>
                      <TD align=middle width="18%" bgColor=#105184><FONT 
                        face=Verdana color=#ffffff size=1><B>City</B></FONT></TD>
                      <TD><INPUT size=38 name=city value="{$smarty.post.city}"> </TD></TR>
                    <TR>
                      <TD vAlign=top align=middle width="18%" 
                        bgColor=#105184><FONT face=Verdana color=#ffffff 
                        size=1><B>Address</B></FONT></TD>
                      <TD><TEXTAREA name=adress rows=3 cols=40>{$smarty.post.adress}</TEXTAREA> 
                    </TD></TR>
					
					<!--<TR>
                      <TD vAlign=top align=middle width="18%" 
                        bgColor=#105184><FONT face=Verdana color=#ffffff 
                        size=1><B>Notes</B></FONT></TD>
                      <TD><TEXTAREA name=notes rows=3 cols=40></TEXTAREA> 
                    </TD></TR>-->
					
					<!--<TR>
                      <TD align=middle width="18%" bgColor=#105184><FONT 
                        face=Verdana color=#ffffff 
size=1><B>Brand</B></FONT></TD>
                      <TD><SELECT name=brand> <OPTION value="" 
                          selected>Select</OPTION> <OPTION 
                          value=Male>b1</OPTION> <OPTION 
                          value=Female>b2</OPTION></SELECT> </TD></TR>-->
					
                    <TR>
                      <TD align=middle width="18%" bgColor=#105184><FONT 
                        face=Verdana color=#ffffff 
size=1><B>Gender</B></FONT></TD>
                      <TD><SELECT name=geneder> <OPTION value="" 
                          selected>Select</OPTION> <OPTION 
                          value=Male {if $smarty.post.geneder eq "Male"}SELECTED{/if}>Male</OPTION> <OPTION 
                          value=Female {if $smarty.post.geneder eq "Female"}SELECTED{/if}>Female</OPTION></SELECT> </TD></TR>
                    <TR>
                      <TD align=middle width="18%" bgColor=#105184><FONT 
                        face=Verdana color=#ffffff size=1><B>Marital 
                        Status</B></FONT></TD>
                      <TD><SELECT name=marital_status> <OPTION value="" 
                          selected>Select</OPTION> <OPTION 
                          value=single {if $smarty.post.marital_status eq "single"}SELECTED{/if}>Single</OPTION> <OPTION 
                          value=married {if $smarty.post.marital_status eq "married"}SELECTED{/if}>Married</OPTION></SELECT> </TD></TR>
                    <TR>
                      <TD align=middle width="18%" bgColor=#105184><FONT 
                        face=Verdana color=#ffffff size=1><B>Date of 
                        Birth</B></FONT></TD>
                      <TD><INPUT name=DOP rel="dateinput" id="datepicker" > </TD></TR>
                    <TR>
                      <TD bgColor=#e6e6e6 colSpan=2><SPAN
                        lang=en-us><B>Communicator</B></SPAN><FONT face=Verdana
                        color=#000000 size=1><B> <SPAN
                        lang=en-us>Status</SPAN></B></FONT> </TD></TR><!--<tr >

                        <td bgColor=#105184 width="18%" align="center">
                        <FONT face=Verdana color=#ffffff size="1"><b>Mobile 3</b></font></td>
                        <td><input type="text" name="mob3" size="38" value=""/>
                         </td>
                         </tr>
                         <tr >

                        <td bgColor=#105184 width="18%" align="center">
                        <FONT face=Verdana color=#ffffff size="1"><b>Mobile 4</b></font></td>
                        <td><input type="text" name="mob4" size="38" value=""/>
                         </td>
                         </tr>-->
                    <TR>
                      <TD align=middle width="18%" bgColor=#105184><FONT 
                        face=Verdana color=#ffffff 
size=1><B>Status</B></FONT></TD>
                      <TD><SELECT name=status_comm> <OPTION value=1 
                          selected>Subscriber</OPTION> <OPTION 
                          value=0 {if $smarty.post.status_comm eq "0"}SELECTED{/if}>Unsubscriber</OPTION></SELECT> </TD></TR>
                    <TR>
                      <TD align=left><SPAN style="COLOR: red">*</SPAN> 
                        Required Fields</TD>
                      <TD align=middle>
						<INPUT class=submit type=submit value="Add"></TD></TR></TBODY></TABLE> </form></TD></TR></TBODY></TABLE></TD>
              </tr>

              </table>
			 
                             	</TR>
				</TBODY>
				</TABLE>
				</DIV>
<div align="center">
	<table border="0" width="900" id="table272">
		<tr>
			<td>
			<p align="right"><font face="Verdana" size="1" color="#666666"><i>
			Developed by </i>ROOT Technologies</font></td>
		</tr>
	</table>
</div>

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