<?php

 $display_form1 .="
  <table border=\"0\" cellpadding=\"0\" cellspacing=\"0\" style=\"border-collapse: collapse; width: 1047px\">
	<colgroup>
		<col width=\"104\" style=\"width: 78pt\">
		<col width=\"104\" style=\"width: 78pt\">
		<col width=\"246\" style=\"width: 185pt\">
		<col width=\"91\" style=\"width: 68pt\">
		<col width=\"91\" style=\"width: 68pt\"><col width=\"99\" style=\"width: 74pt\">
		<col width=\"64\" span=\"2\" style=\"width: 48pt\">
	</colgroup>
	<tr height=\"38\" style=\"height: 28.2pt\">
		<td colspan=\"8\" height=\"38\" style=\"border-left:1px solid; border-right:1px solid; border-top:1px solid; border-bottom:medium none; height: 28.2pt; font-size: 22.0pt; font-family: 'Times New Roman', serif; text-align: center; vertical-align: middle; color: black; font-weight: 400; font-style: normal; text-decoration: none; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">
		<p style=\"text-align: left\"><font face=\"Arial\" size=\"2\">&nbsp;<img border=\"0\" src=\"$loc2/admin/GoTool/forms/fill/Sany_horiz_logo.png\" width=\"230\" height=\"67\"></font><font face=\"Arial\" size=\"6\">&nbsp;&nbsp;
		Registration Request</font><p style=\"text-align: left\">
		<font face=\"Arial\" size=\"2\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Sany America, 318 Cooper Circle, Peachtree
		City, GA 30269&nbsp;&nbsp; - 770-969-2176&nbsp; - services@sanyamerica.com</font></td>
	</tr>
	<tr height=\"20\" style=\"height: 15.0pt\">
		<td height=\"20\" style=\"border-left:1px solid; border-right:1px solid; border-top:medium none; border-bottom:medium none; height: 15.0pt; font-size: 22.0pt; font-family: 'Times New Roman', serif; text-align: center; vertical-align: middle; color: black; font-weight: 400; font-style: normal; text-decoration: none; white-space: nowrap; padding: 0px\" colspan=\"8\" bordercolor=\"#000000\">
		Registration # <input type=\"text\" name=\"1\" size=\"32\" value=\"$van[1]\"></td>
	</tr>
	<tr height=\"19\" style=\"height: 14.4pt\">
		<td height=\"19\" style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; height: 14.4pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">
		&nbsp;</td>
		<td height=\"19\" style=\"height: 14.4pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding: 0px\" bordercolor=\"#000000\">
		&nbsp;</td>
		<td style=\"border-left:medium none windowtext; border-right:medium none windowtext; border-top:medium none windowtext; border-bottom:1px solid windowtext; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">
		&nbsp;</td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding: 0px\" width=\"57\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding: 0px\" width=\"57\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding: 0px\" width=\"351\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding: 0px\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"4\" bordercolor=\"#000000\">&nbsp;</td>
	</tr>
	<tr height=\"19\" style=\"height: 14.4pt\">
		<td height=\"19\" style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; height: 14.4pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">
		&nbsp;</td>
		<td height=\"19\" style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; height: 14.4pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">
		<font face=\"Arial\" size=\"2\">Serial #:</font></td>
		<td style=\"border-bottom:.5pt solid windowtext; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px; border-left-color:windowtext; border-right-color:windowtext; border-top-color:windowtext\" bordercolor=\"#000000\">
		<input type=\"text\" name=\"21\" size=\"32\" value=\"$van[21]\"></td>
		<td style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"57\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding: 0px\" width=\"57\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding: 0px\" width=\"351\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding: 0px\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"4\" bordercolor=\"#000000\">&nbsp;</td>
	</tr>
	<tr height=\"19\" style=\"height: 14.4pt\">
		<td height=\"19\" style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; height: 14.4pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">
		&nbsp;</td>
		<td height=\"19\" style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; height: 14.4pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">
		<font face=\"Arial\" size=\"2\">Date of Registration:</font></td>
		<td style=\"font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; border-right: 1px solid windowtext; border-top: medium none; border-bottom: 1px solid windowtext; padding: 0px; border-left-color:windowtext\" bordercolor=\"#000000\">
		<font face=\"Arial\" size=\"2\">$van[2]</td>
		<td style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"57\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding: 0px\" width=\"57\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding: 0px\" width=\"351\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding: 0px\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"4\" bordercolor=\"#000000\">&nbsp;</td>
	</tr>
	<tr height=\"19\" style=\"height: 14.4pt\">
		<td height=\"19\" style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; height: 14.4pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">&nbsp;</td>
		<td height=\"19\" style=\"height: 14.4pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding: 0px\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"border-left:medium none; border-right:medium none; border-top:1px solid; border-bottom:1px solid; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding: 0px\" width=\"57\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding: 0px\" width=\"57\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding: 0px\" width=\"351\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding: 0px\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"4\" bordercolor=\"#000000\">&nbsp;</td>
	</tr>
	<tr height=\"19\" style=\"height: 14.4pt\">
		<td height=\"19\" style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; height: 14.4pt; font-size: 10.5pt; font-family: 'Times New Roman', serif; text-align: justify; vertical-align: middle; color: black; font-weight: 400; font-style: normal; text-decoration: none; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">
		&nbsp;</td>
		<td height=\"19\" style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; height: 14.4pt; font-size: 10.5pt; font-family: 'Times New Roman', serif; text-align: justify; vertical-align: middle; color: black; font-weight: 400; font-style: normal; text-decoration: none; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">
		<font face=\"Arial\" size=\"2\">Product:</font></td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border-right: 1px solid windowtext; border-bottom: .5pt solid windowtext; padding: 0px; border-left-color:windowtext; border-top-color:inherit\" bordercolor=\"#000000\">
		<font face=\"Arial\" size=\"2\">&nbsp;</font><input type=\"text\" name=\"3\" size=\"32\" value=\"$van[3]\"></td>
		<td style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"57\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding: 0px\" width=\"57\" bordercolor=\"#000000\">
		Start up Date<br/> (mm/dd/yyyy):</td>
		<td style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" colspan=\"3\" bordercolor=\"#000000\"><input type=\"text\" name=\"5\" size=\"32\" value=\"$van[5]\"></td>
	</tr>
	<tr height=\"29\" style=\"height: 21.6pt\">
		<td height=\"29\" style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; height: 21.6pt; font-size: 10.5pt; font-family: 'Times New Roman', serif; text-align: justify; vertical-align: middle; color: black; font-weight: 400; font-style: normal; text-decoration: none; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">
		&nbsp;</td>
		<td height=\"29\" style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; height: 21.6pt; font-size: 10.5pt; font-family: 'Times New Roman', serif; text-align: justify; vertical-align: middle; color: black; font-weight: 400; font-style: normal; text-decoration: none; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">
		<font face=\"Arial\" size=\"2\">Model:</font></td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border-right: 1px solid windowtext; border-top: medium none; border-bottom: 1px solid windowtext; padding: 0px; border-left-color:windowtext\" bordercolor=\"#000000\">
		<font face=\"Arial\" size=\"2\">&nbsp;</font><input type=\"text\" name=\"4\" size=\"32\" value=\"$van[4]\"></td>
		<td style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"57\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding: 0px\" width=\"57\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding: 0px\" width=\"351\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding: 0px\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"4\" bordercolor=\"#000000\">&nbsp;</td>
	</tr>
	<tr height=\"19\" style=\"height: 14.4pt\">
		<td height=\"19\" style=\"border-left:1px solid; border-right:1px solid; border-top:medium none; border-bottom:medium none; height: 14.4pt; font-size: 10.5pt; font-family: 'Times New Roman', serif; text-align: justify; vertical-align: middle; color: black; font-weight: 400; font-style: normal; text-decoration: none; white-space: nowrap; padding: 0px\" colspan=\"8\" bordercolor=\"#000000\">&nbsp;</td>
	</tr>
	<tr height=\"19\" style=\"height: 14.4pt\">
		<td height=\"19\" style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; height: 14.4pt; font-size: 10.5pt; font-family: 'Times New Roman', serif; vertical-align: top; color: black; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">
		&nbsp;</td>
		<td height=\"19\" style=\"height: 14.4pt; font-size: 10.5pt; font-family: 'Times New Roman', serif; vertical-align: top; color: black; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; white-space: nowrap; border: medium none; padding: 0px\" bordercolor=\"#000000\">
		<b><font face=\"Arial\" size=\"2\">Dealer:</font></b></td>
		<td style=\"border-left:medium none windowtext; border-right:medium none windowtext; border-top:medium none windowtext; border-bottom:1px solid windowtext; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">
		<font face=\"Arial\" size=\"2\">&nbsp;</font></td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding: 0px\" width=\"57\" align=\"right\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding: 0px\" width=\"57\" align=\"left\" bordercolor=\"#000000\">
		<b>End User:</b></td>
		<td style=\"border-left:medium none; border-right:medium none; border-top:medium none; border-bottom:1px solid; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"351\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border: medium none; padding: 0px\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"4\" bordercolor=\"#000000\">&nbsp;</td>
	</tr>
	<tr height=\"23\" style=\"height: 17.4pt\">
		<td height=\"23\" style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; height: 17.4pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">
		&nbsp;</td>
		<td height=\"23\" style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; height: 17.4pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">
		Name:</td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border-right: 1px solid windowtext; border-bottom: .5pt solid windowtext; padding: 0px; border-left-color:windowtext; border-top-color:inherit\" bordercolor=\"#000000\">
		<input type=\"text\" name=\"6\" size=\"33\" value=\"$van[6]\"></td>
		<td height=\"23\" style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; height: 17.4pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"57\" align=\"right\" bordercolor=\"#000000\">
		&nbsp;</td>
		<td height=\"23\" style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; height: 17.4pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"56\" align=\"left\" bordercolor=\"#000000\">
		Name:</td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border-left: 1px solid windowtext; border-right: 1px solid windowtext; border-bottom: .5pt solid windowtext; padding: 0px; border-top-color:inherit\" width=\"350\" bordercolor=\"#000000\">
		<input type=\"text\" name=\"14\" size=\"33\" value=\"$van[14]\"></td>
		<td style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"4\" bordercolor=\"#000000\">&nbsp;</td>
	</tr>
	<tr height=\"23\" style=\"height: 17.4pt\">
		<td height=\"23\" style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; height: 17.4pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">
		&nbsp;</td>
		<td height=\"23\" style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; height: 17.4pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">
		Customer ID:</td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border-right: 1px solid windowtext; border-top: medium none; border-bottom: .5pt solid windowtext; padding: 0px; border-left-color:windowtext\" bordercolor=\"#000000\">
         <select size=1 name=cust_idD >
                  <option selected value=$cust_id> $FCL[$cust_id]</option>
                 $display_listCL
                  </select>
		<input type=\"text\" name=\"cust_id\" size=\"13\" value=\"$cust_id\"></td>
		<td height=\"23\" style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; height: 17.4pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"57\" align=\"right\" bordercolor=\"#000000\">
		&nbsp;</td>
		<td height=\"23\" style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; height: 17.4pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"56\" align=\"left\" bordercolor=\"#000000\">
		Customer ID:</td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border-left: 1px solid windowtext; border-right: 1px solid windowtext; border-top: medium none; border-bottom: .5pt solid windowtext; padding: 0px\" width=\"350\" bordercolor=\"#000000\">&nbsp;<input type=\"text\" name=\"cust_id0\" size=\"13\" value=\"$cust_id\"></td>
		<td style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"4\" bordercolor=\"#000000\">&nbsp;</td>
	</tr>
	<tr height=\"23\" style=\"height: 17.4pt\">
		<td height=\"23\" style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; height: 17.4pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">
		&nbsp;</td>
		<td height=\"23\" style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; height: 17.4pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">
		<font face=\"Arial\" size=\"2\">Company Name:</font></td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border-right: 1px solid windowtext; border-top: medium none; border-bottom: .5pt solid windowtext; padding: 0px; border-left-color:windowtext\" bordercolor=\"#000000\">
		<font face=\"Arial\" size=\"2\">&nbsp;</font><input type=\"text\" name=\"7\" size=\"32\" value=\"$van[7]\"></td>
		<td height=\"23\" style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; height: 17.4pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"57\" align=\"right\" bordercolor=\"#000000\">
		&nbsp;</td>
		<td height=\"23\" style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; height: 17.4pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"56\" align=\"left\" bordercolor=\"#000000\">
		<font face=\"Arial\" size=\"2\">Company Name:</font></td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border-left: 1px solid windowtext; border-right: 1px solid windowtext; border-top: medium none; border-bottom: .5pt solid windowtext; padding: 0px\" width=\"350\" bordercolor=\"#000000\">
		<font face=\"Arial\" size=\"2\">&nbsp;</font><input type=\"text\" name=\"15\" size=\"32\" value=\"$van[15]\"></td>
		<td style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"4\" bordercolor=\"#000000\">&nbsp;</td>
	</tr>
	<tr height=\"19\" style=\"height: 14.4pt\">
		<td height=\"19\" style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; height: 14.4pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">
		&nbsp;</td>
		<td height=\"19\" style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; height: 14.4pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">
		<font face=\"Arial\" size=\"2\">Address:</font></td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border-right: 1px solid windowtext; border-top: medium none; border-bottom: .5pt solid windowtext; padding: 0px; border-left-color:windowtext\" bordercolor=\"#000000\">
		<textarea rows=\"3\" name=\"8\" cols=\"32\">$van[8]</textarea><font face=\"Arial\" size=\"2\">&nbsp;</font></td>
		<td height=\"19\" style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; height: 14.4pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"57\" align=\"right\" bordercolor=\"#000000\">
		&nbsp;</td>
		<td height=\"19\" style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; height: 14.4pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"56\" align=\"left\" bordercolor=\"#000000\">
		<font face=\"Arial\" size=\"2\">Address:</font></td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border-left: 1px solid windowtext; border-right: 1px solid windowtext; border-top: medium none; border-bottom: .5pt solid windowtext; padding: 0px\" width=\"350\" bordercolor=\"#000000\">
		<textarea rows=\"3\" name=\"16\" cols=\"32\">$van[16]</textarea><font face=\"Arial\" size=\"2\">&nbsp;</font></td>
		<td style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"4\" bordercolor=\"#000000\">&nbsp;</td>
	</tr>
	<tr height=\"22\" style=\"height: 16.8pt\">
		<td height=\"22\" style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; height: 16.8pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">
		&nbsp;</td>
		<td height=\"22\" style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; height: 16.8pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">
		Postal Code</td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border-right: 1px solid windowtext; border-top: medium none; border-bottom: .5pt solid windowtext; padding: 0px; border-left-color:windowtext\" bordercolor=\"#000000\">
		<input type=\"text\" name=\"9\" size=\"32\" value=\"$van[9]\"></td>
		<td height=\"22\" style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; height: 16.8pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"57\" align=\"right\" bordercolor=\"#000000\">
		&nbsp;</td>
		<td height=\"22\" style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; height: 16.8pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"56\" align=\"left\" bordercolor=\"#000000\">
		Postal Code</td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border-left: 1px solid windowtext; border-right: 1px solid windowtext; border-top: medium none; border-bottom: .5pt solid windowtext; padding: 0px\" width=\"350\" bordercolor=\"#000000\">
		<input type=\"text\" name=\"17\" size=\"32\" value=\"$van[17]\"></td>
		<td style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"4\" bordercolor=\"#000000\">&nbsp;</td>
	</tr>
	<tr height=\"22\" style=\"height: 16.8pt\">
		<td height=\"22\" style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; height: 16.8pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">
		&nbsp;</td>
		<td height=\"22\" style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; height: 16.8pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">
		Country</td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border-right: 1px solid windowtext; border-top: medium none; border-bottom: .5pt solid windowtext; padding: 0px; border-left-color:windowtext\" bordercolor=\"#000000\">
		<input type=\"text\" name=\"10\" size=\"32\" value=\"$van[10]\"></td>
		<td height=\"22\" style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; height: 16.8pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"57\" align=\"right\" bordercolor=\"#000000\">
		&nbsp;</td>
		<td height=\"22\" style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; height: 16.8pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"56\" align=\"left\" bordercolor=\"#000000\">
		Country</td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border-left: 1px solid windowtext; border-right: 1px solid windowtext; border-top: medium none; border-bottom: .5pt solid windowtext; padding: 0px\" width=\"350\" bordercolor=\"#000000\">
		<input type=\"text\" name=\"18\" size=\"32\" value=\"$van[18]\"></td>
		<td style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"4\" bordercolor=\"#000000\">&nbsp;</td>
	</tr>
	<tr height=\"22\" style=\"height: 16.8pt\">
		<td height=\"22\" style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; height: 16.8pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">
		&nbsp;</td>
		<td height=\"22\" style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; height: 16.8pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">
		<font face=\"Arial\" size=\"2\">Tel:</font></td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border-right: 1px solid windowtext; border-top: medium none; border-bottom: medium none windowtext; padding: 0px; border-left-color:windowtext\" bordercolor=\"#000000\">
		<font face=\"Arial\" size=\"2\">&nbsp;</font><input type=\"text\" name=\"11\" size=\"32\" value=\"$van[11]\"></td>
		<td height=\"22\" style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; height: 16.8pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"57\" align=\"right\" bordercolor=\"#000000\">
		&nbsp;</td>
		<td height=\"22\" style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; height: 16.8pt; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"56\" align=\"left\" bordercolor=\"#000000\">
		<font face=\"Arial\" size=\"2\">Tel:</font><p>&nbsp;</td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border-left: 1px solid windowtext; border-right: 1px solid windowtext; border-top: medium none; border-bottom: medium none windowtext; padding: 0px\" width=\"350\" bordercolor=\"#000000\">
		<font face=\"Arial\" size=\"2\">&nbsp;</font><input type=\"text\" name=\"19\" size=\"32\" value=\"$van[19]\"></td>
		<td style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">&nbsp;</td>
		<td style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"4\" bordercolor=\"#000000\">&nbsp;</td>
	</tr>
	<tr height=\"18\" style=\"height: 13.8pt\">
		<td style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; height: 29px; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">
		&nbsp;</td>
		<td style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; height: 29px; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\">
		<font face=\"Arial\" size=\"2\">Fax:</font></td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border-top: medium none; border-bottom: 1px solid windowtext; padding: 0px; border-left-color:windowtext; border-right-color:windowtext\" bordercolor=\"#000000\" height=\"29\">
		<font face=\"Arial\" size=\"2\">&nbsp;</font><input type=\"text\" name=\"12\" size=\"32\" value=\"$van[12]\"></td>
		<td style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; height: 29px; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"57\" align=\"right\" bordercolor=\"#000000\">
		&nbsp;</td>
		<td style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; height: 29px; font-family: Calibri, sans-serif; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"56\" align=\"left\" bordercolor=\"#000000\">
		<font face=\"Arial\" size=\"2\">Fax:</font></td>
		<td style=\"color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; border-top: medium none; border-bottom: 1px solid windowtext; padding: 0px; border-left-color:windowtext; border-right-color:windowtext\" width=\"350\" bordercolor=\"#000000\" height=\"29\">
		<font face=\"Arial\" size=\"2\">&nbsp;</font><input type=\"text\" name=\"20\" size=\"32\" value=\"$van[20]\"></td>
		<td style=\"border-left:1px solid; border-right:medium none; border-top:medium none; border-bottom:medium none; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" bordercolor=\"#000000\" height=\"29\">&nbsp;</td>
		<td style=\"border-left:medium none; border-right:1px solid; border-top:medium none; border-bottom:medium none; color: black; font-size: 11.0pt; font-weight: 400; font-style: normal; text-decoration: none; font-family: Calibri; text-align: general; vertical-align: bottom; white-space: nowrap; padding: 0px\" width=\"4\" bordercolor=\"#000000\" height=\"29\">&nbsp;</td>
	</tr>
	<tr height=\"19\" style=\"height: 14.4pt\">
		<td style=\"border-left:1px solid; border-right:1px solid; border-top:medium none; border-bottom:1px solid; height: 21px; font-size: 10.5pt; font-family: 'Times New Roman', serif; text-align: justify; vertical-align: middle; color: black; font-weight: 400; font-style: normal; text-decoration: none; white-space: nowrap; padding: 0px\" colspan=\"8\" bordercolor=\"#000000\">&nbsp;</td>
	</tr>
	<tr height=\"19\" style=\"height: 14.4pt\">
		<td height=\"19\" style=\"border-left:1px solid; border-right:1px solid; border-top:medium none; border-bottom:1px solid; height: 14.4pt; font-size: 10.5pt; font-family: 'Times New Roman', serif; text-align: justify; vertical-align: middle; color: black; font-weight: 400; font-style: normal; text-decoration: none; white-space: nowrap; padding: 0px\" colspan=\"8\" bordercolor=\"#000000\">
		Signature:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
		<textarea rows=\"3\" name=\"13\" cols=\"32\">$van[13]</textarea></td>
	</tr>

    ";
    $nbr_ligne=$nbr_ligne1;
    //$nbr_ligne=2;
	//        if ($nbr_ligne=$blink){
	//$nbr_ligne=0;
	//        }
	$m=1;

for ($i=0; $i<$m; $i++) {
$j=$i+1;


    // Display only the first line
 //   if ($nbr_ligne == 0) {
    // $nbr_ligne = 1;
  //   }
  //  if ($i >= $nbr_ligne) $display = 'style="display:none"';
            //<input type=\"text\" name=\"PF$i\" size=\"16\" value=\"${PF.$i}\">
 //	 $prod22 .="
//  <tr id=\"cell$i\" $display>
//	<td height=\"53\" style=\"height: 39.6pt; color: black; font-size: 12.0pt; font-weight: 700; font-family: 'Times New Roman', serif; text-align: center; vertical-align: middle; font-style: normal; text-decoration: none; white-space: nowrap; border: .5pt solid windowtext; padding: 0px; background: #D9D9D9\">&nbsp;
//    <input type=\"text\" name=\"PA$i\" size=\"16\" value=\"${PA.$i}\">
//     <a href=\"javascript:void(0)\" onclick=\"javascript:document.getElementById('cell$j').style.display='table-row'; this.style.display='none'\">[+]</a></td>
//		</td>

//	    ";
}

 $display_form2 .="

</table>
 ";

?>
