<TR>
<TD>
<!-- cell_ck_300_getaddr.txt

Version 2 RF 981210
   variable and whitespace cleanup
Version 1 GF 981207
-->


<!---------- Name ------------------------>

<FONT FACE="helvetica,arial,san-serif" SIZE=-1>Name:</FONT> 
<FONT FACE="helvetica,arial,san-serif" SIZE=-2 COLOR="#FF0000">__NAME_err__</font>
<BR>
<INPUT TYPE="text" NAME="NAME_inp" SIZE="35" VALUE="__NAME_inp__">
<BR>

<!---------- Address 1 -------------------->

<FONT FACE="helvetica,arial,san-serif" SIZE=-1>Street Address:</FONT> 
<FONT FACE="helvetica,arial,san-serif" SIZE=-2 COLOR="#FF0000">__ADDRESS1_err__</font>
<BR>
<INPUT TYPE="text" NAME="ADDRESS1_inp" SIZE="35" VALUE="__ADDRESS1_inp__">
<BR>

<!---------- Address 2 ------------------->

<FONT FACE="helvetica,arial,san-serif" SIZE=-1>Extra Address Line:</FONT> 
<FONT FACE="helvetica,arial,san-serif" SIZE=-2 COLOR="#FF0000">__ADDRESS2_err__</font>
<BR>
<INPUT TYPE="text" NAME="ADDRESS2_inp" SIZE="35" VALUE="__ADDRESS2_inp__">
<BR>

<!---------- City ------------------------>

<FONT FACE="helvetica,arial,san-serif" SIZE=-1>City:</FONT> 
<FONT FACE="helvetica,arial,san-serif" SIZE=-2 COLOR="#FF0000">__CITY_err__</font>
<BR>
<INPUT TYPE="text" NAME="CITY_inp" SIZE="35" VALUE="__CITY_inp__">
<BR>

<!---------- State ------------------------>

<FONT FACE="helvetica,arial,san-serif" SIZE=-1>State:</FONT> 
<FONT FACE="helvetica,arial,san-serif" SIZE=-2 COLOR="#FF0000">__STATE_err__</font>
<BR>

<input type="hidden" name="STATE_pre" value="__STATE_inp__">
<SELECT NAME="STATE_inp">
__STATE_SELECT__
</SELECT>
<BR>

<!---------- Zip --------------------------> 

<FONT FACE="helvetica,arial,san-serif" SIZE=-1>Zip Code:</FONT> 
<FONT FACE="helvetica,arial,san-serif" SIZE=-2 COLOR="#FF0000">__POSTCODE_err__</font>
<BR>
<INPUT TYPE="text" NAME="POSTCODE_inp" SIZE="15" MAXLENGTH=9 VALUE="__POSTCODE_inp__">
<BR>

<!---------- Phone ------------------------> 

<FONT FACE="helvetica,arial,san-serif" SIZE=-1>Daytime Phone number:</FONT> 
<FONT FACE="helvetica,arial,san-serif" SIZE=-2 COLOR="#FF0000">__DAYPHONE_err__</font>
<BR>
<INPUT TYPE="text" NAME="DAYPHONE_inp" SIZE="15" MAXLENGTH=15 VALUE="__DAYPHONE_inp__">
<P>

</TD>
</TR>

