| <input name="l_sname" type="text" size="45" maxlength="50"> |
| <input name="l_email" type="text" size="45" maxlength="255"> |
| <input name="l_rname" type="text" size="45" maxlength="50"> |
| <input name="l_rcname" type="text" size="45" maxlength="50"> |
| <input name="l_raddress1" type="text" size="45" maxlength="50"> |
| <input name="l_raddress2" type="text" size="45" maxlength="50"> |
| <input name="l_rcity" type="text" size="45" maxlength="50"> |
| <input name="l_rcounty" type="text" size="45" maxlength="50"> |
| <input name="l_rpostcode" type="text" size="20" maxlength="20"> |
| <input name="l_content" type="text" size="45"> |
| <input name="l_plocation" type="text" size="10" maxlength="10"> |
| <input name="l_pb_url" type="text" size="45"> |
| <input name="l_cid" type="hidden" value="--YOUR VALUE--"> |
| <input name="l_key" type="hidden" value="--YOUR VALUE--"> |
| <input name="l_fb_emails" type="hidden" value="--YOUR VALUE--"> |
