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<!--E68-->
<html>
<head>
<meta http-equiv="Content-Type" content="text/html; charset=<X-FC-ITEM DATA[Charset]>">
<title><X-FC-FIELD LANG.68.0.25 STRING></title>
<style type="text/css">
<!--
<!--#include virtual="/.templates/GlobalStyles.inc"-->
-->
</style>
</head>
<body dir="<X-FC-FIELD LANG.7500 DEFAULT="ltr" STRING>" bgcolor="<X-FC-FIELD PREFS.5600 DEFAULT=LANG.49.5600.11 RGB>"<X-FC-BACKGROUND-PICTURE HTML> leftmargin="0" rightmargin="0" topmargin="0" marginwidth="0" marginheight="0">
<form action="<X-FC-OBJURL SLASH>FormSave" method="post" enctype="multipart/form-data">
<input type="hidden" name="CharSet" value="<X-FC-ITEM DATA[CharSet]>"><!--#set var="TABLEWIDTH" value="<X-FC-FIELD PREFS.5720 DEFAULT=LANG.49.5720.9 STRING>"-->
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<tr>
<td><img src="/Icons/0" width="5" height="32" border="0"></td>
<td class="title" nowrap><X-FC-FIELD LANG.68.0.25 STRING></td>
<td width="100%"> </td>
<td><input type="submit" class="button" value=" <X-FC-FIELD LANG.CMD.5.0 STRING> "></td>
<td><input type="reset" class="button" value=" <X-FC-FIELD LANG.CMD.7.0 STRING> " onClick="document.forms['ResetForm'].submit();return false;"></td>
<td> </td>
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<tr>
<td bgcolor="<X-FC-FIELD PREFS.5604 DEFAULT=LANG.49.5604.11 RGB>"> </td>
<td bgcolor="<X-FC-FIELD PREFS.5604 DEFAULT=LANG.49.5604.11 RGB>" class="p" nowrap> <label for="F1"><X-FC-FIELD LANG.68.1003.9 STRING></label></td>
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<td bgcolor="<X-FC-FIELD PREFS.5604 DEFAULT=LANG.49.5604.11 RGB>" class="p" nowrap> <label for="F4"><X-FC-FIELD LANG.68.1004.9 STRING></label></td>
<td bgcolor="<X-FC-FIELD PREFS.5604 DEFAULT=LANG.49.5604.11 RGB>" class="p" width="100%"> </td>
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<tr>
<td rowspan="5"> </td>
<td><input name="FieldID:2000=STRING" type="text" class="forms" id="F1" size="25" value="<X-FC-FIELD 2000 STRING>"></td>
<td><input name="FieldID:2001=STRING" type="text" class="forms" id="F2" size="15" value="<X-FC-FIELD 2001 STRING>"></td>
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<td rowspan="5" width="100%"> </td>
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<tr>
<td><input name="FieldID:2010=STRING" type="text" class="forms" id="F1" size="25" value="<X-FC-FIELD 2010 STRING>"></td>
<td><input name="FieldID:2011=STRING" type="text" class="forms" id="F2" size="15" value="<X-FC-FIELD 2011 STRING>"></td>
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<tr>
<td><input name="FieldID:2020=STRING" type="text" class="forms" id="F1" size="25" value="<X-FC-FIELD 2020 STRING>"></td>
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<tr>
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<td><input name="FieldID:2032=STRING" type="password" class="forms" id="F3" size="15" value="<X-FC-FIELD 2032 STRING>"></td>
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<tr>
<td><input name="FieldID:2040=STRING" type="text" class="forms" id="F1" size="25" value="<X-FC-FIELD 2040 STRING>"></td>
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<tr>
<td colspan="6"><img src="/Icons/0" width="1" height="5" border="0"></td>
</tr>
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<tr>
<td><table cellpadding="2" cellspacing="0" border="0" align="center">
<tr>
<td> </td>
<td><input type="submit" class="button" value=" <X-FC-FIELD LANG.CMD.5.0 STRING> "></td>
<td><input type="reset" class="button" value=" <X-FC-FIELD LANG.CMD.7.0 STRING> " onClick="document.forms['ResetForm'].submit();return false;"></td>
<td> </td>
</tr>
</table></td>
</tr>
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</form>
<form name="ResetForm" action="<X-FC-OBJURL SLASH>FormSave?Clear=0&TargetURL=<X-FC-OBJURL>" method="post">
<input type="hidden" name="Close" value="1">
</form>
<!--#include virtual="/.templates/toolbars/FooterForm.inc"-->
</body>
</html>
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