</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>