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<td id="plain" width="160"><X-FC-FIELD FORM.1082.9 STRING></td>
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<tr>
<td><img src="/Icons/0" width="1" height="5" border="0"></td>
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<tr>
<td bgcolor="<X-FC-FIELD PREFS.5603 DEFAULT=LANG.49.5603.11 RGB>"><img src="/Icons/0" width="1" height="3" border="0"></td>
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<tr>
<td><table bgcolor="<X-FC-FIELD PREFS.5604 DEFAULT=LANG.49.5604.11 RGB>" cellpadding="0" cellspacing="0" border="0">
<tr>
<td nowrap><font id="heading1" size="4"> <X-FC-FIELD FORM.4104.25 STRING></font></td>
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<tr>
<td><img src="/Icons/0" width="1" height="5" border="0"></td>
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<tr>
<td><table cellpadding="2" cellspacing="0" border="0">
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<td> </td>
<td id="plain" nowrap><X-FC-FIELD FORM.1052.9 STRING></td>
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<tr>
<td><img src="/Icons/0" width="1" height="3" border="0"></td>
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<tr>
<td><table cellpadding="2" cellspacing="0" border="0">
<tr>
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<td id="plain" nowrap><X-FC-FIELD FORM.1053.9 STRING></td>
<td><table bgcolor="#D6D3CE" cellpadding="0" cellspacing="0" border="0" class="ocb">
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<map name="PMMAP:1800.0">
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<td class="ict" bgcolor="#FFFFFF"><input class="nb" type="text" name="Input:1800.0" value="<X-FC-FIELD 1800 DEFAULT=PROP.11 NUMFIELD>" size="10" onKeyPress="return VNKS(event);" onBlur="VNF(1800,0,this);" onFocus="this.select();"></td>
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<td class="icb"><img src="/Icons/9160" width="11" height="13" hspace="1" vspace="1" border="0" usemap="#LMAP:1800.0"></td><!--#endif-->
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<td id="plain" width="160"><X-FC-FIELD FORM.1055.9 STRING></td>
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<tr>
<td id="plain" nowrap><X-FC-FIELD FORM.1054.9 STRING></td>
<td><table bgcolor="#D6D3CE" cellpadding="0" cellspacing="0" border="0" class="ocb">
<tr>
<map name="PMMAP:1801.0">
<area shape="rect" coords="0,0,11,7" href="JavaScript://" <!--#echo var="ALTSTR"-->="<X-FC-FIELD LANG.7535.5 STRING>" onClick="INF(1801,0,1);return false;"></area>
<area shape="rect" coords="0,8,11,13" href="JavaScript://" <!--#echo var="ALTSTR"-->="<X-FC-FIELD LANG.7535.6 STRING>" onClick="INF(1801,0,-1);return false;"></area>
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<map name="LMAP:1801.0">
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<td class="ict" bgcolor="#FFFFFF"><input class="nb" type="text" name="Input:1801.0" value="<X-FC-FIELD 1801 DEFAULT=PROP.11 NUMFIELD>" size="10" onKeyPress="return VNKS(event);" onBlur="VNF(1801,0,this);" onFocus="this.select();"></td>
<td class="icb"><img src="/Icons/10746" width="11" height="13" hspace="1" vspace="1" border="0" usemap="#PMMAP:1801.0"></td><!--#if expr="<X-FC-FIELD FORM.1801.10 LENGTH>"-->
<td class="icb"><img src="/Icons/9160" width="11" height="13" hspace="1" vspace="1" border="0" usemap="#LMAP:1801.0"></td><!--#endif-->
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<td> </td>
<td id="plain" width="160"><X-FC-FIELD FORM.1000.9 STRING></td>
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<tr>
<td id="bold" colspan="4" nowrap><X-FC-FIELD FORM.1001.9 STRING></td>
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<tr>
<td id="plain" nowrap><X-FC-FIELD FORM.1014.9 STRING></td>
<td><select name="FieldID:1802=LONG"><!--#set var="CURVAL" value="0"--><!--#set var="LISTSTRING" value="<X-FC-FIELD FORM.1802.10 LITERALSTRING>"--><!--#while expr="$LISTSTRING"--><!--#set var="VALUE" expr="@split($LISTSTRING,';')"--><!--#set var="CAPTION"
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<td id="plain" width="160"><X-FC-FIELD FORM.1042.9 STRING></td>
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<tr>
<td id="plain" nowrap><X-FC-FIELD FORM.1018.9 STRING></td>
<td valign="top"><input name="FieldID:1803=STRING" type="text" size="20" value="<X-FC-FIELD 1803 STRING>"></td>
<td id="plain" width="160"><X-FC-FIELD FORM.1023.9 STRING></td>
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<tr>
<td id="plain" nowrap><X-FC-FIELD FORM.1039.9 STRING></td>
<td><table bgcolor="#D6D3CE" cellpadding="0" cellspacing="0" border="0" class="ocb">
<tr>
<map name="PMMAP:1804.0">
<area shape="rect" coords="0,0,11,7" href="JavaScript://" <!--#echo var="ALTSTR"-->="<X-FC-FIELD LANG.7535.5 STRING>" onClick="INF(1804,0,1);return false;"></area>
<area shape="rect" coords="0,8,11,13" href="JavaScript://" <!--#echo var="ALTSTR"-->="<X-FC-FIELD LANG.7535.6 STRING>" onClick="INF(1804,0,-1);return false;"></area>
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<map name="LMAP:1804.0">
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<td class="ict" bgcolor="#FFFFFF"><input class="nb" type="text" name="Input:1804.0" value="<X-FC-FIELD 1804 DEFAULT=PROP.11 NUMFIELD>" size="10" onKeyPress="return VNKS(event);" onBlur="VNF(1804,0,this);" onFocus="this.select();"></td>
<td class="icb"><img src="/Icons/10746" width="11" height="13" hspace="1" vspace="1" border="0" usemap="#PMMAP:1804.0"></td><!--#if expr="<X-FC-FIELD FORM.1804.10 LENGTH>"-->
<td class="icb"><img src="/Icons/9160" width="11" height="13" hspace="1" vspace="1" border="0" usemap="#LMAP:1804.0"></td><!--#endif-->
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<td id="plain" width="160"><X-FC-FIELD FORM.1040.9 STRING></td>
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</table></td>
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<tr>
<td><img src="/Icons/0" width="1" height="5" border="0"></td>
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<tr>
<td bgcolor="<X-FC-FIELD PREFS.5603 DEFAULT=LANG.49.5603.11 RGB>"><img src="/Icons/0" width="1" height="3" border="0"></td>
</tr>
<tr>
<td><table bgcolor="<X-FC-FIELD PREFS.5604 DEFAULT=LANG.49.5604.11 RGB>" cellpadding="0" cellspacing="0" border="0">
<tr>
<td nowrap><font id="heading1" size="4"> <X-FC-FIELD FORM.4105.25 STRING></font></td>
<td width="100%"> </td>
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<tr>
<td><img src="/Icons/0" width="1" height="5" border="0"></td>
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<tr>
<td><table cellpadding="2" cellspacing="0" border="0">
<tr>
<td> </td>
<td id="plain" nowrap><X-FC-FIELD FORM.1046.9 STRING></td>
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</table></td>
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<tr>
<td><img src="/Icons/0" width="1" height="3" border="0"></td>
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<tr>
<td><table cellpadding="2" cellspacing="0" border="0">
<tr>
<td> </td>
<td><input type="checkbox"<!--#if expr="<X-FC-FIELD 1202 DEFAULT=0 NUMBER>"--> checked<!--#endif--> onClick="this.form.elements['FieldID:1202=SHORT'].value=(this.checked?1:0);"></td>
<td id="plain" nowrap><X-FC-FIELD FORM.1202.9 STRING></td>
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<td id="plain" width="150"><X-FC-FIELD FORM.1002.9 STRING></td>
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</table></td>
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<tr>
<td><table cellpadding="2" cellspacing="0" border="0">
<tr>
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<td id="plain" nowrap><X-FC-FIELD FORM.1047.9 STRING></td>
<td><input type="text" name="FieldID:1203=STRING" size="25" value="<X-FC-FIELD 1203 STRING>"></td>
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<td id="plain" width="150"><X-FC-FIELD FORM.1048.9 STRING></td>
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<tr>
<td id="plain" nowrap><X-FC-FIELD FORM.4046.9 STRING></td>
<td><input type="text" name="FieldID:1200=STRING" size="25" value="<X-FC-FIELD 1200 STRING>"></td>
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<tr>
<td id="plain" nowrap><X-FC-FIELD FORM.4047.9 STRING></td>
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<tr>
<td><img src="/Icons/0" width="1" height="5" border="0"></td>
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<tr>
<td bgcolor="<X-FC-FIELD PREFS.5603 DEFAULT=LANG.49.5603.11 RGB>"><img src="/Icons/0" width="1" height="3" border="0"></td>
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<tr>
<td><table bgcolor="<X-FC-FIELD PREFS.5604 DEFAULT=LANG.49.5604.11 RGB>" cellpadding="0" cellspacing="0" border="0">
<tr>
<td nowrap><font id="heading1" size="4"> <X-FC-FIELD FORM.5000.25 STRING></font></td>
<td width="100%"> </td>
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<tr>
<td><img src="/Icons/0" width="1" height="5" border="0"></td>
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<tr>
<td><table cellpadding="2" cellspacing="0" border="0">
<tr>
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<td id="plain" nowrap><X-FC-FIELD FORM.1013.9 STRING></td>
<td><table bgcolor="#D6D3CE" cellpadding="0" cellspacing="0" border="0" class="ocb">
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<td id="plain" width="160"><X-FC-FIELD FORM.1012.9 STRING></td>
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<tr>
<td id="plain" nowrap><X-FC-FIELD FORM.4006.9 STRING></td>
<td><table bgcolor="#D6D3CE" cellpadding="0" cellspacing="0" border="0" class="ocb">
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<td> </td>
<td id="plain" width="160"><X-FC-FIELD FORM.1026.9 STRING></td>
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<tr>
<td id="plain" nowrap><X-FC-FIELD FORM.1016.9 STRING></td>
<td><table bgcolor="#D6D3CE" cellpadding="0" cellspacing="0" border="0" class="ocb">
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<map name="PMMAP:1523.0">
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<td class="ict" bgcolor="#FFFFFF"><input class="nb" type="text" name="Input:1523.0" value="<X-FC-FIELD 1523 DEFAULT=PROP.11 NUMFIELD>" size="10" onKeyPress="return VNKS(event);" onBlur="VNF(1523,0,this);" onFocus="this.select();"></td>
<td class="icb"><img src="/Icons/10746" width="11" height="13" hspace="1" vspace="1" border="0" usemap="#PMMAP:1523.0"></td><!--#if expr="<X-FC-FIELD FORM.1523.10 LENGTH>"-->
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</table></td>
<td> </td>
<td id="plain" width="160"><X-FC-FIELD FORM.1015.9 STRING></td>
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</table></td>
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<tr>
<td><img src="/Icons/0" width="1" height="5" border="0"></td>
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<table bgcolor="<X-FC-FIELD PREFS.5603 DEFAULT=LANG.49.5603.11 RGB>" width="<!--#echo var="TABLEWIDTH"-->" cellpadding="0" cellspacing="0" border="0">
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<td><table cellpadding="2" cellspacing="0" border="0" align="center">
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<td><input type="submit" value=" <X-FC-FIELD LANG.CMD.5.0 STRING> "></td>
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