%
%
%my( $cust_main, $pre, $onchange, $disabled ) = @_;
%my $conf = new FS::Conf;
%
%#false laziness with ship state
%my $countrydefault = $conf->config('countrydefault') || 'US';
%$cust_main->set($pre.'country', $countrydefault )
%  unless $cust_main->get($pre.'country');
%
%my $statedefault = $conf->config('statedefault')
%                   || ($countrydefault eq 'US' ? 'CA' : '');
%$cust_main->set($pre.'state', $statedefault )
%  unless $cust_main->get($pre.'state')
%         || $cust_main->get($pre.'country') ne $countrydefault;
%
%#my($county_html, $state_html, $country_html) =
%#  FS::cust_main_county::regionselector( $cust_main->get($pre.'county'),
%#                                        $cust_main->get($pre.'state'),
%#                                        $cust_main->get($pre.'country'),
%#                                        $pre,
%#                                        $onchange,
%#                                        $disabled,
%#                                      );
%
%my %select_hash = (
%  'county'   => $cust_main->get($pre.'county'),
%  'state'    => $cust_main->get($pre.'state'),
%  'country'  => $cust_main->get($pre.'country'),
%  'prefix'   => $pre,
%  'onchange' => $onchange,
%  'disabled' => $disabled,
%);
%
%my $daytime_label = FS::Msgcat::_gettext('daytime') || 'Day Phone';
%my $night_label = FS::Msgcat::_gettext('night') || 'Night Phone';
%
%my $r = qq!<font color="#ff0000">*</font>&nbsp;!;
%
%


<% &ntable("#cccccc") %>

<TR>
  <TH ALIGN="right"><%$r%>Contact&nbsp;name<BR>(last,&nbsp;first)</TH>
  <TD COLSPAN=3>
    <INPUT TYPE="text" NAME="<%$pre%>last" VALUE="<% $cust_main->get($pre.'last') %>" onChange="<% $onchange %>" <%$disabled%>> , 
    <INPUT TYPE="text" NAME="<%$pre%>first" VALUE="<% $cust_main->get($pre.'first') %>" onChange="<% $onchange %>" <%$disabled%>>
  </TD>
% if ( $conf->exists('show_ss') && !$pre ) { 

  <TD ALIGN="right">SS#</TD>
  <TD><INPUT TYPE="text" NAME="ss" VALUE="<% $cust_main->ss %>" SIZE=11></TD>
% } elsif ( !$pre ) { 

  <TD><INPUT TYPE="hidden" NAME="ss" VALUE="<% $cust_main->ss %>"></TD>
% } 


</TR>

<TR>
  <TD ALIGN="right">Company</TD>
  <TD COLSPAN=5>
    <INPUT TYPE="text" NAME="<%$pre%>company" VALUE="<% $cust_main->get($pre.'company') %>" SIZE=70 onChange="<% $onchange %>" <%$disabled%>>
  </TD>
</TR>

<TR>
  <TH ALIGN="right"><%$r%>Address</TH>
  <TD COLSPAN=5>
    <INPUT TYPE="text" NAME="<%$pre%>address1" VALUE="<% $cust_main->get($pre.'address1') %>" SIZE=70 onChange="<% $onchange %>" <%$disabled%>>
  </TD>
</TR>

<TR>
  <TD ALIGN="right">&nbsp;</TD>
  <TD COLSPAN=5>
    <INPUT TYPE="text" NAME="<%$pre%>address2" VALUE="<% $cust_main->get($pre.'address2') %>" SIZE=70 onChange="<% $onchange %>" <%$disabled%>>
  </TD>
</TR>

<TR>
  <TH ALIGN="right"><%$r%>City</TH>
  <TD>
    <INPUT TYPE="text" NAME="<%$pre%>city" VALUE="<% $cust_main->get($pre.'city') %>" onChange="<% $onchange %>" <%$disabled%>>
  </TD>
  <TH ALIGN="right"><%$r%>State</TH>
  <TD>
    <% include('select-county.html', %select_hash ) %>
    <% include('select-state.html', %select_hash ) %>
  </TD>
  <TH><%$r%>Zip</TH>
  <TD>
    <INPUT TYPE="text" NAME="<%$pre%>zip" VALUE="<% $cust_main->get($pre.'zip') %>" SIZE=10 onChange="<% $onchange %>" <%$disabled%>>
  </TD>
</TR>

<TR>
  <TH ALIGN="right"><%$r%>Country</TH>
  <TD COLSPAN=5><% include('select-country.html', %select_hash ) %></TD>
</TR>

<TR>
  <TD ALIGN="right"><% $daytime_label %></TD>
  <TD COLSPAN=5>
    <INPUT TYPE="text" NAME="<%$pre%>daytime" VALUE="<% $cust_main->get($pre.'daytime') %>" SIZE=18 onChange="<% $onchange %>" <%$disabled%>>
  </TD>
</TR>

<TR>
  <TD ALIGN="right"><% $night_label %></TD>
  <TD COLSPAN=5>
    <INPUT TYPE="text" NAME="<%$pre%>night" VALUE="<% $cust_main->get($pre.'night') %>" SIZE=18 onChange="<% $onchange %>" <%$disabled%>>
  </TD>
</TR>

<TR>
  <TD ALIGN="right">Fax</TD>
  <TD COLSPAN=5>
    <INPUT TYPE="text" NAME="<%$pre%>fax" VALUE="<% $cust_main->get($pre.'fax') %>" SIZE=12 onChange="<% $onchange %>" <%$disabled%>>
  </TD>
</TR>

</TABLE>
<%$r%>required fields<BR>