</tr>
<tr>
<td><label for="FirstName"> First Name </label></td>
<td><input name="FirstName" type="text" id="FirstName"
maxlength="40" size="20"
value="<?php
if (isset($gFirstName)) {
echo $gFirstName;
}
?>
" />
</td>
<td> </td>
<td><label for="State">* State </label></td>
<td> <select name="State"><?php
echo StateDropdown('VA', 'mixed');
?>
</select>
</td>
</tr>
<tr>
<td><label for="LastName"> Last Name </label></td>
<td><input name="LastName" type="text" id="LastName"
maxlength="80" size="20"
value="<?php
if (isset($gLastName)) {
echo $gLastName;
}
?>
" />
</td>
?>
<p><b>Shipping Information:</b></p>
<form action="confirmpayment.php" method="post">
<table border="0">
<tr>
<td>Address: </td>
<td><input name="addr" type="text" size="50" placeholder="123 Fake Street" /></td></tr>
<tr>
<td>City: </td>
<td><input name="city" type="text" size="50" placeholder="City" />
</td></tr>
<tr>
<td>State: </td>
<td><select name="state"><?php
StateDropdown("MN", "abbrev");
?>
</select>
</td></tr>
<tr>
<td>Zip Code: </td>
<td><input name="zip" type="text" size="10" placeholder="00000" />
</td></tr>
<tr>
<td>Shipping Method: </td>
<td><select name="shipping">
<option value="1">Pack Mule - $3.99</option>
<option value="2">Carrier Pigeon - $9.99</option>
<option value="3">Clowns on Unicycle - $14.99</option>
<option value="4">Quantum Teleportation - $44.99</option>
</select>
