{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="">
    <table width="50%" border="0" cellspacing="0" cellpadding="5" align="center">
      <tr class="hproduct1">
	            <td ><a href="index.php">Admin Home</a></td>
	<td  align="right"><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%">  
            Comment / Question :</td>
        <td width="57%"> 
		<textarea name="comment" value="" cols="30" rows="3">{COMMENT}</textarea>
          </td>
      </tr>
      <tr class="hproduct2"> 
        <td> Keyword: 
            </td>
        <td> 
          <input type="text" name="keyword" value="{KEYWORD}">
          </td>
      </tr >
	   <tr class="hproduct2"> 
        <td> Industry
            </td>
        <td> 
          <input type="text" name="industry" value="Bakery Business">
          </td>
      </tr >
	       
	        <tr class="hproduct3"> 
        <td width="43%">  
            City :</td>
        <td width="57%"> 
          <input type="text" name="city" value="{CITY}">
          </td>
      </tr>
      <tr class="hproduct2"> 
        <td> State
            :</td>
        <td> 
          <input type="text" name="state" value="{STATE}">
          </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>
    </table>
	<input type="hidden" name="mode" value="{GET1}">
	<input type="hidden" name="isposted" value="">
	<input type="hidden" name="id" value="{GET2}">
	</form>
        </TD>
  </tr>
</table>
{FOOTER}