<fieldset class="paf">
<table border="0">
	<tbody>
		<tr>
			<td class="label">{yourName title}</td> 			
			<td>{yourName value}</td> 		
		</tr>
		<tr>
			<td class="label">{companyName title}</td> 			
			<td>{companyName value}</td> 		
		</tr>
		<tr>
			<td class="label">{phoneNumber title}</td> 			
			<td>{phoneNumber value}</td> 		
		</tr>
		<tr>
			<td class="label">{emailAddress title}</td> 			
			<td>{emailAddress value}</td> 		
		</tr>
		<tr>
			<td class="label">{product_description title}</td> 			
			<td>{product_description value} </td> 		
		</tr>
		<tr>
			<td class="label">{webAddress title}</td> 			
			<td>{webAddress value}</td> 		
		</tr>
		<tr>
			<td class="label">{productValue title}</td> 			
			<td>{productValue value}</td> 		
		</tr>
		<tr>
			<td class="label">{message title}</td> 			
			<td>{message value}</td> 		
		</tr>
		<tr>
			<td class="label">{productName title}</td> 			
			<td>{productName value}</td> 		
		</tr>
		<tr>
			<td class="label">{num_prizes title}</td> 			
			<td>{num_prizes value}</td> 		
		</tr>
		<tr>
			<td>&nbsp;</td> 			
			<td>{SUBMIT} {RESET}</td> 		
		</tr>
		<tr>
			<td>&nbsp;</td> 			
			<td>{REQUIRED_STAR}</td> 		
		</tr>
	</tbody>
</table>
</fieldset>
