</TR>
<TR>
+ <TD ALIGN="right">Last Application: </TD>
+ <TD>
+ <INPUT TYPE="text" NAME="lastapp" VALUE="" >
+ </TD>
+ </TR>
+
+ <TR>
<TD ALIGN="right">Freeside service #: </TD>
<TD>
<INPUT TYPE="text" NAME="svcnum" VALUE="<% join(',', @svcnum ) %>" >