<INPUT TYPE="hidden" NAME="magic" VALUE="process">
<INPUT TYPE="hidden" NAME="ref" VALUE="<%= $referral_custnum %>">
<INPUT TYPE="hidden" NAME="ss" VALUE="">
+Where did you hear about our service? <SELECT NAME="refnum">
+<%=
+ $OUT .= '<OPTION VALUE="">' unless $refnum;
+ foreach my $part_referral ( @{$init_data->{'part_referral'}} ) {
+ $OUT .= '<OPTION VALUE="'. $part_referral->{'refnum'}. '"';
+ $OUT .= ' SELECTED' if $part_referral->{'refnum'} eq $refnum;
+ $OUT .= '>'. $part_referral->{'referral'};
+ }
+%>
+</SELECT><BR><BR>
Contact Information
<TABLE BGCOLOR="#c0c0c0" BORDER=0 CELLSPACING=0 WIDTH="100%">
<TR>