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						<td class="instruction">All Fields are required</td>
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						<td class="instruction">All Fields are required</td>
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                    </tr>
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                    </tr>
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                <tr>
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                <tr>
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					<td class="label" align="right"><sup>*</sup>Name:</td>
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					<td class="label" align="right"><sup>*</sup>Name:</td>
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					<td class="input">
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					<td class="input">
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						<input type="text" id="shipName" name="name" value="$fullname" class="searchbox right" />
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						<input type="text" id="shipName" name="name" class="searchbox right" />
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					</td>
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					</td>
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				</tr>
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				</tr>
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                <tr>
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                <tr>
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					<td class="label" align="right"><sup>*</sup>Address Line 1:</td>
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					<td class="label" align="right"><sup>*</sup>Address Line 1:</td>
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					<td class="input">
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					<td class="input">