<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">{webAddress title}</td> 			
			<td>{webAddress 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">{paymentMethod title}</td> 			
			<td>{paymentMethod value}</td> 		
		</tr>
		<tr>
			<td class="label">{dealOffer title}</td> 			
			<td>{dealOffer value}</td> 		
		</tr>
		<tr>
			<td class="label">{approxValue title}</td> 			
			<td>{approxValue value}</td> 		
		</tr>
		<tr>
			<td class="label">{startDate title}</td> 			
			<td>{startDate value}</td> 		
		</tr>
		<tr>
			<td class="label">{endDate title}</td> 			
			<td>{endDate value}</td> 		
		</tr>
		<tr>
			<td class="label">{offerDescription title}</td> 			
			<td>{offerDescription value} </td> 		
		</tr>
		<tr>
			<td class="label">{offerRestrictions title}</td> 			
			<td>{offerRestrictions value} </td> 		
		</tr>
		<tr>
			<td class="label">{message title}</td> 			
			<td>{message value}</td> 		
		</tr>
		<tr>
			<td>&nbsp;</td> 			
			<td>{SUBMIT} {RESET}</td> 		
		</tr>
		<tr>
			<td>&nbsp;</td> 			
			<td>{REQUIRED_STAR}</td> 		
		</tr>
	</tbody>
</table>
</fieldset>
