<div class="form_item">
  <div class="form_element cf_heading">
    <h1 class="cf_text">Community Marketing Setup</h1>
  </div>
  <div class="cfclear">&nbsp;</div>
</div>

<div class="form_item">
  <div class="form_element cf_textbox">
    <label class="cf_label" style="width: 150px;">Franchise Owners Name</label>
    <input class="cf_inputbox required" maxlength="150" size="30" title="" id="text_2" name="owner" type="text" />
  
  </div>
  <div class="cfclear">&nbsp;</div>
</div>

<div class="form_item">
  <div class="form_element cf_text"> <span class="cf_text">Credit Card Billing Address</span> </div>
  <div class="cfclear">&nbsp;</div>
</div>

<div class="form_item">
  <div class="form_element cf_textarea">
    <label class="cf_label" style="width: 150px;">Address</label>
    <textarea class="cf_inputbox required" rows="3" id="text_16" title="" cols="30" name="Address"></textarea>
    
  </div>
  <div class="cfclear">&nbsp;</div>
</div>

<div class="form_item">
  <div class="form_element cf_textbox">
    <label class="cf_label" style="width: 150px;">City</label>
    <input class="cf_inputbox required" maxlength="150" size="30" title="" id="text_14" name="city" type="text" />
  
  </div>
  <div class="cfclear">&nbsp;</div>
</div>

<div class="form_item">
  <div class="form_element cf_textbox">
    <label class="cf_label" style="width: 150px;">Postal Code</label>
    <input class="cf_inputbox required" maxlength="150" size="30" title="" id="text_15" name="postalcode" type="text" />
  
  </div>
  <div class="cfclear">&nbsp;</div>
</div>

<div class="form_item">
  <div class="form_element cf_text"> <span class="cf_text">Credit Card Information</span> </div>
  <div class="cfclear">&nbsp;</div>
</div>

<div class="form_item">
  <div class="form_element cf_textbox">
    <label class="cf_label" style="width: 150px;">Name On Card</label>
    <input class="cf_inputbox required" maxlength="150" size="30" title="" id="text_4" name="name" type="text" />
  
  </div>
  <div class="cfclear">&nbsp;</div>
</div>

<div class="form_item">
  <div class="form_element cf_textbox">
    <label class="cf_label" style="width: 150px;">Credit Card Number</label>
    <input class="cf_inputbox required" maxlength="150" size="30" title="" id="text_8" name="cc" type="text" />
  
  </div>
  <div class="cfclear">&nbsp;</div>
</div>

<div class="form_item">
  <div class="form_element cf_textbox">
    <label class="cf_label" style="width: 150px;">Expire Date</label>
    <input class="cf_inputbox required" maxlength="150" size="30" title="" id="text_11" name="expdate" type="text" />
  
  </div>
  <div class="cfclear">&nbsp;</div>
</div>

<div class="form_item">
  <div class="form_element cf_textbox">
    <label class="cf_label" style="width: 150px;">3 Digit Card Code</label>
    <input class="cf_inputbox required" maxlength="150" size="30" title="" id="text_5" name="csv" type="text" />
  <a class="tooltiplink" onclick="return false;"><img height="16" border="0" width="16" class="tooltipimg" alt="" src="components/com_chronocontact/css/images/tooltip.png"/></a>
				<div class="tooltipdiv">3 Digit Card Code :: Found on back of card</div>
  </div>
  <div class="cfclear">&nbsp;</div>
</div>

<div class="form_item">
  <div class="form_element cf_textbox">
    <label class="cf_label" style="width: 150px;">Card Type</label>
    <input class="cf_inputbox required" maxlength="150" size="30" title="" id="text_9" name="cardtype" type="text" />
  
  </div>
  <div class="cfclear">&nbsp;</div>
</div>

<div class="form_item">
  <div class="form_element cf_button">
    <input value="Submit" name="button_11" type="submit" />
  </div>
  <div class="cfclear">&nbsp;</div>
</div>
