<option value=''></option>
<?php
$type_list = gen_contact_types($dbh, $case_id);
echo $type_list;
?>
</select></p>
<p><label>Address</label><textarea name="address"></textarea></p>
<p><label>City</label><input type="text" name="city"></p>
<p><label>State</label><?php
$select = state_selector('state', 'state_select');
echo $select;
?>
</p>
<p><label>Zip</label><input type="text" name="zip"></p>
<span class="contact_phone_widget"></span>
<span class="contact_email_widget"></span>
<p><label>Website</label><input type="text" name="url"></p>
<p><label>Notes</label><textarea name="notes" class="contact_notes"></textarea></p>
</div>
<label class="control-label">Phone</label>
<div class="controls">
<select name="phone_type" class="inline small-select">
<option value="mobile">Mobile</option>
<option value="home">Home</option>
<option value="work">Work</option>
<option value="other">Other</option>
</select>
<input type="text" name="phone" class="phoneUS">
</div>
</div>
<p><label>Address</label><textarea name="address"></textarea></p>
<p><label>City</label><input type="text" name="city"></p>
<p><label>State</label>
<?php
echo state_selector('state', 'state');
?>
</p>
<p><label>Zip</label><input type="text" name="zip"></p>
<p><label>Notes</label>
<textarea name="notes"></textarea>
</p>
<input type="hidden" name="action" value="add">
<p><button class="btn btn-success">Add</button>
</p>
</form>
<?php
} else {
echo "<p>You do not have permission to add contacts.</p>";
}