<CENTER><font size="+1"><?php echo $form_title?></font></CENTER>
<HR>
<TABLE WIDTH="100%">
<TR>
 <TD ALIGN="right"><?php echo $label_username?></TD>
 <TD><INPUT NAME="username" VALUE="<?php echo $username?>" size="50"></TD>
</TR>
<TR>
 <TD ALIGN="right"><?php echo $label_useraddress?></TD>
 <TD><INPUT NAME="useraddress" VALUE="<?php echo $useraddress?>" size="50"></TD>
</TR>
<TR>
 <TD ALIGN="right"><?php echo $label_short_description?>:</TD>
 <TD><INPUT NAME="subject" VALUE="<?php echo $subject?>" size="50"></TD>
</TR>
<TR>
 <TD ALIGN="right">&nbsp;</TD>
 <TD><B><?php echo $label_comments?>:</B><BR>
<TEXTAREA NAME="body" id="body" ROWS="5" COLS="60"><?php echo $body?></TEXTAREA></TD>
</TR>
</TABLE>