{HEADER}
<script language="javascript">
function validate(typ)
{
	document.frm.isposted.value=typ;
	if(confirm("Save Changes"))
	{
		document.frm.submit();
	}
}
function makeCheck(form,check)
{
var options = form.elements['curl[]']
for (var i = 0;i < options.length; i++)
	options[i].checked = check
} 
</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="hproduct3"> 
					<td width="43%">  
						Prepop Url :
					</td>
					<td width="57%"> 
						<textarea name="url" rows="5" cols="25">{PREPOPURL}</textarea>
					</td>
				</tr>
				<tr class="hproduct2"> 
					<td> Number of Times:</td>
					<td> 
						<input type="text" name="noftimes" value="{NOFTIMES}">
					</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 align="center" class="hproduct2"> 
					<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 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}