24 lines
1.8 KiB
PHP
24 lines
1.8 KiB
PHP
<table width='100%'>
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<tr>
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<td align='left'>
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<p class='align-left'><b><label for='dialog_business_name'>Business Name</label>:</b><br>
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<input type='text' name='business_name' id='dialog_business_name' size='40' class="form-field text ui-widget-content ui-corner-all"></p>
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<p class='align-left'><b><label for='dialog_address'>Address</label>:</b><br>
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<input type='text' name='address' id='dialog_address' size='40' class="form-field text ui-widget-content ui-corner-all"></p>
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<p class='align-left'><b><label for='dialog_city'>City</label>:</b><br>
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<input type='text' name='city' id='dialog_city' size='40' class="form-field text ui-widget-content ui-corner-all"></p>
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<p class='align-left'><b><label for='dialog_province'>Province</label>:</b><br>
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<input type='text' name='province' id='dialog_province' size='20' class="form-field text ui-widget-content ui-corner-all"></p>
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<p class='align-left'><b><label for='dialog_contact_name'>Contact Name</label>:</b><br>
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<input type='text' name='contact_name' id='dialog_contact_name' size='40' class="form-field text ui-widget-content ui-corner-all"></p>
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<p class='align-left'><b><label for='dialog_phone'>Contact Phone</label>:</b><br>
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<input type='text' name='phone' id='dialog_phone' size='20' class="form-field text ui-widget-content ui-corner-all"></p>
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<p class='align-left'><b><label for='dialog_email'>Contact Email</label>:</b><br>
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<input type='text' name='email' id='dialog_email' size='40' class="form-field text ui-widget-content ui-corner-all"></p>
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<p class='align-left'><b><label for='dialog_reseller_code'>Reseller Code</label>:</b><br>
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<input type='text' name='reseller_code' id='dialog_reseller_code' size='40' class="form-field text ui-widget-content ui-corner-all"></p>
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</td>
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</tr>
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</table>
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