<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN">

<html>

	<head>
		<meta http-equiv="content-type" content="text/html;charset=iso-8859-1">
		<meta name="generator" content="Adobe GoLive">
		<title>Customer Information</title>
		
	</head>

	<body bgcolor="#e6e6fa">
    <?php
     $order = $HTTP_GET_VARS;
     $id = $order["id"];
     $group = $order["Group"];
     $page = $order["Page"];
     $total = $order["total"];
     $curr = $order["currency"];
     ?>
	<form action="Thanks.php" method="post" name="user">
	<input type="hidden" name="id" value="<? echo $id; ?>">
    <input type="hidden" name="total" value="<? echo $total; ?>">
    <input type="hidden" name="currency" value="<? echo $curr; ?>">
		<table width="80%" border="0" cellspacing="0" cellpadding="0" align="center">
			<tr>
				<td colspan="4" bgcolor="#191970"><br>
					<div align="center">
						<h2><font color="#e6e6fa" face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">Customer Information</font></h2>
					</div>
				</td>
			</tr>
			<tr height="15">
				<td bgcolor="#e6e6fa" width="20%" height="15"></td>
				<td bgcolor="#e6e6fa" height="15"></td>
				<td bgcolor="#e6e6fa" height="15"></td>
				<td bgcolor="#e6e6fa" width="20%" height="15"></td>
			</tr>
			<tr>
				<td bgcolor="#e6e6fa" width="20%"></td>
				<td bgcolor="#e6e6fa"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">Salutation</font></td>
				<td bgcolor="#e6e6fa"><SELECT name=salutation >
                        <OPTION selected value="">
						<OPTION value="Mister">Mister
						<OPTION value="Misses">Misses</OPTION>
					</SELECT></td>
				<td bgcolor="#e6e6fa" width="20%"></td>
			</tr>
			<tr>
				<td bgcolor="#e6e6fa" width="20%"></td>
				<td bgcolor="#e6e6fa"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">First Name</font></td>
				<td bgcolor="#e6e6fa"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"><input type="text" name="firstname" size="12" border="0"></font></td>
				<td bgcolor="#e6e6fa" width="20%"></td>
			</tr>
			<tr>
				<td bgcolor="#e6e6fa" width="20%"></td>
				<td bgcolor="#e6e6fa"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">Last Name</font></td>
				<td bgcolor="#e6e6fa"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"><input type="text" name="name" size="12" border="0"></font></td>
				<td bgcolor="#e6e6fa" width="20%"></td>
			</tr>
			<tr height="10">
				<td bgcolor="#e6e6fa" width="20%" height="10"></td>
				<td bgcolor="#e6e6fa" height="10"></td>
				<td bgcolor="#e6e6fa" height="10"></td>
				<td bgcolor="#e6e6fa" width="20%" height="10"></td>
			</tr>
			<tr>
				<td bgcolor="#e6e6fa" width="20%"></td>
				<td bgcolor="#e6e6fa"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">Address 01</font></td>
				<td bgcolor="#e6e6fa"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"><input type="text" name="street" size="12" border="0"></font></td>
				<td bgcolor="#e6e6fa" width="20%"></td>
			</tr>
            <tr>
				<td bgcolor="#e6e6fa" width="20%"></td>
				<td bgcolor="#e6e6fa"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">Address 02</font></td>
				<td bgcolor="#e6e6fa"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"><input type="text" name="number" size="4" border="0"></font></td>
				<td bgcolor="#e6e6fa" width="20%"></td>
			</tr>
			<tr>
				<td bgcolor="#e6e6fa" width="20%"></td>
				<td bgcolor="#e6e6fa"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">Zip Code/Post Code</font></td>
				<td bgcolor="#e6e6fa"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"><input type="text" name="area" size="6" border="0"></font></td>
				<td bgcolor="#e6e6fa" width="20%"></td>
			</tr>
			<tr>
				<td bgcolor="#e6e6fa" width="20%"></td>
				<td bgcolor="#e6e6fa"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">City/Town</font></td>
				<td bgcolor="#e6e6fa"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"><input type="text" name="city" size="12" border="0"></font></td>
				<td bgcolor="#e6e6fa" width="20%"></td>
			</tr>
				<tr>
					<td bgcolor="#e6e6fa" width="20%"></td>
					<td bgcolor="#e6e6fa"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">State/Prefecture</font></td>
					<td bgcolor="#e6e6fa"><input type="text" name="state" size="12" border="0"></td>
					<td bgcolor="#e6e6fa" width="20%"></td>
				</tr>
				<tr>
				<td bgcolor="#e6e6fa" width="20%"></td>
				<td bgcolor="#e6e6fa"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">Country</font></td>
				<td bgcolor="#e6e6fa"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"><input type="text" name="country" size="12" border="0"></font></td>
				<td bgcolor="#e6e6fa" width="20%"></td>
			</tr>
			<tr>
				<td bgcolor="#e6e6fa" width="20%"></td>
				<td bgcolor="#e6e6fa"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">e-mail</font></td>
				<td bgcolor="#e6e6fa"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"><input type="text" name="mail" size="12" border="0"></font></td>
				<td bgcolor="#e6e6fa" width="20%"></td>
			</tr>
			<tr>
				<td bgcolor="#e6e6fa" width="20%"></td>
				<td bgcolor="#e6e6fa"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">Payment</font></td>
				<td bgcolor="#e6e6fa"><SELECT name="payment">
						<OPTION 
              value="bill">bill</SELECT></td>
				<td bgcolor="#e6e6fa" width="20%"></td>
			</tr>
			<tr height="10">
				<td bgcolor="#e6e6fa" width="20%" height="10"></td>
				<td bgcolor="#e6e6fa" height="10"></td>
				<td bgcolor="#e6e6fa" height="10"></td>
				<td bgcolor="#e6e6fa" width="20%" height="10"></td>
			</tr>
			<tr>
				<td bgcolor="#e6e6fa" width="20%"></td>
				<td bgcolor="#e6e6fa"></td>
				<td bgcolor="#e6e6fa"><font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular"><input type="reset" border="0"><input type="submit" name="submitButtonName" border="0"></font></td>
				<td bgcolor="#e6e6fa" width="20%"></td>
			</tr>
			<tr>
				<td bgcolor="#e6e6fa" width="20%">
    	        <a  href="Products.php?Group=<? echo $group."&Page=".$page."&id=".$id; ?>">
                <font face="Arial,Helvetica,Geneva,Swiss,SunSans-Regular">
                back </font></a></td>
				<td bgcolor="#e6e6fa"></td>
				<td bgcolor="#e6e6fa"></td>
				<td bgcolor="#e6e6fa" width="20%"></td>
			</tr>
		</table>
		<p></p></form>
	</body>

</html>
