<TD ALIGN="right" VALIGN="center"><% mt('Address') |h %></TD>
<TD><INPUT TYPE="text" NAME="address" SIZE=54></TD>
</TR>
+
+ <TR>
+ <TD ALIGN="right" VALIGN="center"><% mt('County') |h %></TD>
+ <TD>
+ <& /elements/select-county.html,
+ disable_empty => 0,
+ empty_label => '(all)',
+ &>
+ </TD>
+ </TR>
+
+
+ <TR>
+ <TD ALIGN="right" VALIGN="center"><% mt('State') |h %></TD>
+ <TD>
+ <& /elements/select-state.html,
+ disable_empty => 0,
+ empty_label => '(all)',
+ &>
+ </TD>
+ </TR>
<TR>
<TD ALIGN="right" VALIGN="center"><% mt('Zip') |h %></TD>
<TD><INPUT TYPE="text" NAME="zip" SIZE=12></TD>
</TR>
+ <TR>
+ <TD ALIGN="right" VALIGN="center"><% mt('Country') |h %></TD>
+ <TD>
+ <& /elements/select-country.html,
+ disable_empty => 0,
+ state_disable_empty => 0,
+ state_empty_label => '(all)',
+ &>
+ </TD>
+ </TR>
+
<TR>
<TD ALIGN="right" VALIGN="center"><% mt('Signup date') |h %></TD>
<TD>