{HEADER}
<script language="javascript">
		function validate(typ)
		{
					
			document.frm.isposted.value=typ;

			if(confirm("Save Changes"))
			{
				document.frm.submit();
			}
		}
</script>
<table width="780" height="80%" border="0" align="center" cellpadding="0" cellspacing="0">
<tr>
      <TD background="../img/bg.jpg" vAlign=top align="center" class="thank">
	  <br><form name="frm" method="post" action="" enctype="multipart/form-data">
    <table width="75%" border="0" cellspacing="0" cellpadding="5">
        <tr class="hproduct1"> 
            <td  class="product-d1"><a href="index.php">Admin Home</a></td>
            <td   align="right" class="product-d1" ><a href="login_view.php?mode=d">Logout</a></td>
          </tr>
	  <tr align="center" > 
        <td colspan="2" class="hproduct"> 
          Admin Input Form </td>
      </tr>
      <tr align="center" class="hproduct1"> 
        <td colspan="2" >{HEADERTXT}</td>
      </tr>
      <tr class="hproduct2"> 
        <td width="43%">  
            Text Display after the Form Detail Sent to the Database :</td>
        <td width="57%">
							<textarea name="thankyou_text" rows="10" cols="45">{THANKYOU_TEXT}</textarea>
          </td>
      </tr>
   	   <tr class="hproduct1"> 
        <td width="43%">  
            Country :</td>
        <td width="57%"> 
		    <select name="country">
				<option value="United States" {STR1} >United States</option>
				<option value="Canada" {STR2}>Canada</option>
				<option value="International"{STR3}>International</option>
			</select>
          </td>
       </tr>
	   <tr class="hproduct1"> 
        <td width="43%">  
            Capital to Invest :</td>
            <td ><select name="cap_inv" id="cap_inv">
                <option value="">-- Select one --</option>
								<!-- BEGIN option -->
									<option value={VALUE} {OPTION} >{OPTION1}</option>
								<!-- END option -->
								</select></td>
       </tr>
	        <tr align="center" class="hproduct1"> 
        <td colspan="2" align="center" valign="top" > 
				{INPUT1}
				&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 
          <INPUT TYPE="button" value="Back" onClick="history.back();">
					{HTML}
					        </td>
      </tr>
      </tr>
      <tr align="center" class="hproduct1"> 
        <td colspan="2" align="center" valign="top" > 
     	<input type="hidden" name="mode" value="{GET1}">
	    <input type="hidden" name="isposted" value="">
	    <input type="hidden" name="id" value="{GET2}">
        </td>
      </tr>
    </table>
	</form>
        </TD>
  </tr>
</table>
{FOOTER}