rendered paste body<link rel="stylesheet" type="text/css" href="main.css">
<html>
<head>
<meta name="generator" content="PhpED Version 5.0 (Build 5025)">
<title>Business Registration</title>
</head>
<body>
<div id="bizform">
<form name="bizform" id="bizform" method="post" target="_self" title="Business Registration" action="enroll.php?action=add">
<div class="level">
<h4>Membership Level</h4>
<input type="radio" name="level" id="level" value="Gold" align="left" checked onclick="submit();">Gold<br>
<input type="radio" name="level" id="level" value="Silver" align="left" onclick="submit();">Silver<br>
<input type="radio" name="level" id="level" value="Basic" align="left" onclick="submit();">Basic<br>
</div>
<span class="required">·</span><span class="bizformtitle">Business Name:</span>
<input type="text" name="bname" id="bname" align="left" size="50" maxlength="50" class="bizformfield" ><br />
<span class="required">·</span><span class="bizformtitle">User Name:</span>
<input type="text" name="uname" id="uname" align="left" size="12" maxlength="8" class="bizformfield" ><br />
<span class="required">·</span><span class="bizformtitle">Password:</span>
<input type="password" name="pass" id="pass" align="left" size="12" maxlength="8" class="bizformfield"><br />
<span class="required">·</span><span class="bizformtitle">Confirm Password:</span>
<input type="password" name="cpass" id="cpass" align="left" size="12" maxlength="8" class="bizformfield"><br />
<span class="required">·</span><span class="bizformtitle">Contact Name:</span>
<input type="text" name="cname" id="cname" align="left" size="50" maxlength="50" class="bizformfield" ><br />
<span class="required">·</span><span class="bizformtitle">Address 1:</span>
<input type="text" name="address1" id="address1" align="left" size="50" maxlength="50" class="bizformfield" ><br />
<span class="required"> </span><span class="bizformtitle">Address 2:</span>
<input type="text" name="address2" id="address2" align="left" size="50" maxlength="50" class="bizformfield" ><br />
<span class="required">·</span><span class="bizformtitle">City:</span>
<input type="text" name="city" id="city" align="left" size="50" maxlength="50" class="bizformfield" ><br />
<span class="required">·</span><span class="bizformtitle">State:</span>
<select name="state" id="state" size="1" class="bizformfield">
<option value="0">Please select...</option>
<option value="Australian Capital Territory">Australian Capital Territory</option>
<option value="New South Wales">New South Wales</option>
<option value="Northern Territory">Northern Territory</option>
<option value="Queensland">Queensland</option>
<option value="South Australia">South Australia</option>
<option value="Tasmania">Tasmania</option>
<option value="Victoria">Victoria</option>
<option value="Western Australia">Western Australia</option>
</select><br />
<span class="required">·</span><span class="bizformtitle">Zip Code:</span>
<input type="text" name="zip" id="zip" align="left" size="6" maxlength="4" class="bizformfield" ><br />
<span class="required">·</span><span class="bizformtitle">Office Phone:</span>
<input type="text" name="ophone" id="ophone" align="left" size="12" maxlength="16" class="bizformfield" ><br />
<span class="required"> </span><span class="bizformtitle">Fax:</span>
<input type="text" name="fax" id="fax" align="left" size="12" maxlength="16" class="bizformfield" ><br />
<span class="required"> </span><span class="bizformtitle">Cell Phone:</span>
<input type="text" name="cphone" id="cphone" align="left" size="12" maxlength="16" class="bizformfield" ><br />
<span class="required"> </span><span class="bizformtitle">Web Site:</span>
<input type="text" name="web" id="web" align="left" size="50" maxlength="50" class="bizformfield" ><br />
<span class="required"> </span><span class="bizformtitle">Email:</span>
<input type="text" name="email" id="email" align="left" size="50" maxlength="50" class="bizformfield" ><br />
<span class="required"> </span><span class="bizformtitle">Notes:</span>
<textarea name="notes" id="notes" rows="6" cols="50" wrap="virtual" align="left" class="bizformtextbox"></textarea><br />
<span class="required"> </span><span class="bizformtitle">Services:</span>
<span class="required">·</span><span class="bizformtitleNum">1</span>
<input type="text" name="service1" id="service1" align="left" size="24" maxlength="20" class="bizformfield" ><br />
<span class="required"> </span><span class="bizformtitle"> </span>
<span class="required">·</span><span class="bizformtitleNum">2</span>
<input type="text" name="service2" id="service2" align="left" size="24" maxlength="20" class="bizformfield" ><br />
<span class="required"> </span><span class="bizformtitle"> </span>
<span class="required">·</span><span class="bizformtitleNum">3</span>
<input type="text" name="service3" id="service3" align="left" size="24" maxlength="20" class="bizformfield" ><br />
<span class="required"> </span><span class="bizformtitle"> </span>
<span class="required">·</span><span class="bizformtitleNum">4</span>
<input type="text" name="service4" id="service4" align="left" size="24" maxlength="20" class="bizformfield" ><br />
<span class="required"> </span><span class="bizformtitle"> </span>
<span class="required">·</span><span class="bizformtitleNum">5</span>
<input type="text" name="service5" id="service5" align="left" size="24" maxlength="20" class="bizformfield" ><br />
<span class="required"> </span><span class="bizformtitle"> </span>
<span class="required">·</span><span class="bizformtitleNum">6</span>
<input type="text" name="service6" id="service6" align="left" size="24" maxlength="20" class="bizformfield" ><br />
<span class="required"> </span><span class="bizformtitle"> </span>
<span class="required">·</span><span class="bizformtitleNum">7</span>
<input type="text" name="service7" id="service7" align="left" size="24" maxlength="20" class="bizformfield" ><br />
<span class="required"> </span><span class="bizformtitle"> </span>
<span class="required">·</span><span class="bizformtitleNum">8</span>
<input type="text" name="service8" id="service8" align="left" size="24" maxlength="20" class="bizformfield" ><br />
<span class="required"> </span><span class="bizformtitle"> </span>
<span class="required">·</span><span class="bizformtitleNum">9</span>
<input type="text" name="service9" id="service9" align="left" size="24" maxlength="20" class="bizformfield" ><br />
<span class="required"> </span><span class="bizformtitle"> </span>
<span class="required">·</span><span class="bizformtitleNum">10</span>
<input type="text" name="service10" id="service10" align="left" size="24" maxlength="20" class="bizformfield" ><br />
<span class="required"> </span><span class="bizformtitle"> </span>
<span class="required">·</span><span class="bizformtitleNum">11</span>
<input type="text" name="service11" id="service11" align="left" size="24" maxlength="20" class="bizformfield" ><br />
<span class="required"> </span><span class="bizformtitle"> </span>
<span class="required">·</span><span class="bizformtitleNum">12</span>
<input type="text" name="service12" id="service12" align="left" size="24" maxlength="20" class="bizformfield" ><br />
<span class="required"> </span><span class="bizformtitle"> </span>
<span class="required">·</span><span class="bizformtitleNum">13</span>
<input type="text" name="service13" id="service13" align="left" size="24" maxlength="20" class="bizformfield" ><br />
<span class="required"> </span><span class="bizformtitle"> </span>
<span class="required">·</span><span class="bizformtitleNum">14</span>
<input type="text" name="service14" id="service14" align="left" size="24" maxlength="20" class="bizformfield" ><br />
<span class="required"> </span><span class="bizformtitle"> </span>
<span class="required">·</span><span class="bizformtitleNum">15</span>
<input type="text" name="service15" id="service15" align="left" size="24" maxlength="20" class="bizformfield" ><br />
</div>
<input type="submit" name="submit" id="submit" value="Submit">
</form>
</body>
</html>