+ 'censustract' => $opt{'censustract'},
+&>
+
+<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%> <%$style%>>
+ </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%> <%$style%>>
+ </TD>
+</TR>
+
+<TR>
+ <TD ALIGN="right"><% $mobile_label %></TD>
+ <TD COLSPAN=5>
+ <INPUT TYPE="text" NAME="<%$pre%>mobile" VALUE="<% $cust_main->get($pre.'mobile') %>" SIZE=18 onChange="<% $onchange %>" <%$disabled%> <%$style%>>
+ </TD>
+</TR>
+
+<TR>
+ <TD ALIGN="right"><% mt('Fax') |h %></TD>
+ <TD COLSPAN=5>
+ <INPUT TYPE="text" NAME="<%$pre%>fax" VALUE="<% $cust_main->get($pre.'fax') %>" SIZE=12 onChange="<% $onchange %>" <%$disabled%> <%$style%>>
+ </TD>
+</TR>
+
+% } else {