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  </tr>
  <tr>
		<td class="common"><a href="javascript:popUp('../user/xml/help/company.html','250','120')">
    	<img src="../images/infosmall.jpg" align="absmiddle" border="0" /> </a>Company<span class="stars">*</span>
    </td>
    <td><input name="COMPANY" value="{COMPANY}" type="text" style="width: 100%;" tabindex="4" /></td>
  </tr>
  <tr>
		<td class="common"><a href="javascript:popUp('../user/xml/help/companyphone.html','250','120')">
    	<img src="../images/infosmall.jpg" align="absmiddle" border="0" /> </a>Telephone <span class="stars">*</span>
    </td>
    <td><input name="PHONE" value="{PHONE}" type="text" style="width: 100%;" tabindex="5" /></td>
  </tr>
    <tr>
	<td class="common"><a href="javascript:popUp('../support/xml/help/region.html','250','120')">
    	<img src="../images/infosmall.jpg" align="absmiddle" border="0" /> </a> Sales Region<span class="stars">*</span></td>
    	<td>
	<select NAME="REGION" style="width: 100%;" tabindex="6" >
	<option value="">[Select Region]</option>
       	<option value="North West England">North West England</option>
	<option value="North East England">North East England</option>
	<option value="South East England">South East England</option>
	<option value="Central England">Central England</option>
	<option value="Scotland">Scotland</option>
	<option value="Wales">Wales</option>
	<option value="Northern Ireland">Northern Ireland</option>
	<option value="Republic of Ireland">Republic of Ireland</option>
	</select>
	</td>
    </tr>
  <tr>
  	<td> </td>
  </tr>
  <tr>
  	<td></td>
    <td class="common" align="center">
     	<input class="input-button" type="submit" value="Submit Information" tabindex="7" ></input>
			<input class="input-button" type="reset" value="Reset" tabindex="8" ></input>
     </td>
  </tr>
</table>

</form>
</mi:execute>
</td>

&navigation-right;
</tr>
</table>
&footer;
</body>
</html>