<div style="margin-bottom: 10px; margin-top: 10px;" class="table-summary">
    <h2>
        ClientExec OpenSRS Registration Form
    </h2>
    <br />
    {SNAPIN_HEADER}
</div>
<br />
<table width='100%' cellpadding=0 border=0 cellspacing=0>
    <tr>
        <td class="snapshot-header-left">
        </td>
        <td class="snapshot-header" nowrap>
            <font class=snapshot-header-description>
            </font>
        </td>
        <td class="snapshot-header" align=right>
        </td>
        <td class="snapshot-header-right">
        </td>
    </tr>
</table>

<!-- BEGIN DYNAMIC BLOCK: signupForm -->
<div align="center" style="color:red">
    {ERR}
</div>

<div>
    <form method='post' action='index.php?fuse=admin&amp;view=Snapins&amp;plugin=opensrsform'>
        <div style="clear:both;margin-top:10px;float:left;width:105px;margin-left:10px;margin-right:10px;">
            Admin E-mail:
        </div>
        <div style='margin-top:10px;float:left;overflow:hidden;'>
            <input type="text" name="admin_email" size="30" style="width:244px;" value="{ADMINEMAIL}" />
        </div>
        
        <div style="clear:both;margin-top:10px;float:left;width:105px;margin-left:10px;margin-right:10px;">
            Organization:
        </div>
        <div style='margin-top:10px;float:left;overflow:hidden;'>
            <input type="text" name="org_name" size="30" style="width:244px;" value="{ORGANIZATION}" />
        </div>
        
        <div style="clear:both;margin-top:10px;float:left;width:105px;margin-left:10px;margin-right:10px;">
            First Name:
        </div>
        <div style='margin-top:10px;float:left;overflow:hidden;'>
            <input type="text" name="first_name" size="30" style="width:244px;" value="{FNAME}" />
        </div>
        
        <div style="clear:both;margin-top:10px;float:left;width:105px;margin-left:10px;margin-right:10px;">
            Last Name:
        </div>
        <div style='margin-top:10px;float:left;overflow:hidden;'>
            <input type="text" name="last_name" size="30" style="width:244px;" value="{LNAME}" />
        </div>
        
        <div style="clear:both;margin-top:10px;float:left;width:105px;margin-left:10px;margin-right:10px;">
            E-mail:
        </div>
        <div style='margin-top:10px;float:left;overflow:hidden;'>
            <input type="text" name="email" size="30" style="width:244px;" value="{EMAIL}" />
        </div>
        
        <div style="clear:both;margin-top:10px;float:left;width:105px;margin-left:10px;margin-right:10px;">
            Address Line 1:
        </div>
        <div style='margin-top:10px;float:left;overflow:hidden;'>
            <input type="text" name="address1" size="30" style="width:244px;" value="{ADDRESS1}" />
        </div>
        
        <div style="clear:both;margin-top:10px;float:left;width:105px;margin-left:10px;margin-right:10px;">
            Address Line 2:
        </div>
        <div style='margin-top:10px;float:left;overflow:hidden;'>
            <input type="text" name="address2" size="30" style="width:244px;" value="{ADDRESS2}" />
        </div>
        
        <div style="clear:both;margin-top:10px;float:left;width:105px;margin-left:10px;margin-right:10px;">
            Address Line 3:
        </div>
        <div style='margin-top:10px;float:left;overflow:hidden;'>
            <input type="text" name="address3" size="30" style="width:244px;" value="{ADDRESS3}" />
        </div>
        
        <div style="clear:both;margin-top:10px;float:left;width:105px;margin-left:10px;margin-right:10px;">
            City:
        </div>
        <div style='margin-top:10px;float:left;overflow:hidden;'>
            <input type="text" name="city" size="30" style="width:244px;" value="{CITY}" />
        </div>
        
        <div style="clear:both;margin-top:10px;float:left;width:105px;margin-left:10px;margin-right:10px;">
            State:
        </div>
        <div style='margin-top:10px;float:left;overflow:hidden;'>
            <input type="text" name="state" size="30" style="width:244px;" value="{STATE}" />
        </div>
        
        <div style="clear:both;margin-top:10px;float:left;width:105px;margin-left:10px;margin-right:10px;">
            Country:
        </div>
        <div style='margin-top:10px;float:left;overflow:hidden;'>
            <select name="country" style="width:248px;">
                {COUNTRY}
            </select>
        </div>
        
        <div style="clear:both;margin-top:10px;float:left;width:105px;margin-left:10px;margin-right:10px;">
            Postal Code:
        </div>
        <div style='margin-top:10px;float:left;overflow:hidden;'>
            <input type="text" name="postal_code" size="30" style="width:244px;" value="{POSTALCODE}" />
        </div>
        
        <div style="clear:both;margin-top:10px;float:left;width:105px;margin-left:10px;margin-right:10px;">
            Phone:
        </div>
        <div style='margin-top:10px;float:left;overflow:hidden;'>
            <input type="text" name="phone" size="30" style="width:244px;" value="{PHONE}" />
        </div>
        
        <div style="clear:both;margin-top:10px;float:left;width:105px;margin-left:10px;margin-right:10px;">
            Fax:
        </div>
        <div style='margin-top:10px;float:left;overflow:hidden;'>
            <input type="text" name="fax" size="30" style="width:244px;" value="{FAX}" />
        </div>
        
        <!--
        <div style="clear:both;margin-top:10px;float:left;width:105px;margin-left:10px;margin-right:10px;">
            Nameserver 1:
        </div>
        <div style='margin-top:10px;float:left;overflow:hidden;'>
            <input type="text" name="fqdn1" size="30" style="width:244px;" value="{FQDN1}" />
        </div>
        
        <div style="clear:both;margin-top:10px;float:left;width:105px;margin-left:10px;margin-right:10px;">
            Nameserver 2:
        </div>
        <div style='margin-top:10px;float:left;overflow:hidden;'>
            <input type="text" name="fqdn2" size="30" style="width:244px;" value="{FQDN2}" />
        </div>
        
        <div style="clear:both;margin-top:10px;float:left;width:105px;margin-left:10px;margin-right:10px;">
            Nameserver 3:
        </div>
        <div style='margin-top:10px;float:left;overflow:hidden;'>
            <input type="text" name="fqdn3" size="30" style="width:244px;" value="{FQDN3}" />
        </div>
        -->
        
        <div style="clear:both;margin-top:10px;float:left;width:105px;margin-left:10px;margin-right:10px;">
            Username:
        </div>
        <div style='margin-top:10px;float:left;overflow:hidden;'>
            <input type="text" name="username" size="30" style="width:244px;" value="{ID}" />
        </div>
        
        <div style="clear:both;margin-top:10px;float:left;width:105px;margin-left:10px;margin-right:10px;">
            Password:
        </div>
        <div style='margin-top:10px;float:left;overflow:hidden;'>
            <input type="text" name="password" size="30" style="width:244px;" value="{PW}" />
        </div>
        
        <div style="clear:both;margin-top:10px;float:left;width:105px;margin-left:10px;margin-right:10px;">
        </div>
        <div style='margin-top:10px;float:left;overflow:hidden;'>
            <input type="checkbox" name="agree" />
            <a href="../plugins/snapins/opensrsform/Services_Agreement.html" target="_blank">Agree to the TUCOWS master services agreement</a>
        </div>
        
        <div style="clear:both;padding-top:15px;">
            <input type="submit" class="button" name="submit" value='Sign Up' />
        </div>
    </form>
</div>
<!-- END DYNAMIC BLOCK: signupForm -->

<!-- BEGIN DYNAMIC BLOCK: successPage -->
<div style="clear:both;padding-top:15px;">
    {SUCCESSMESSAGE}
</div>
<!-- END DYNAMIC BLOCK: successPage -->