
<form id="crepair-form" action="crepair/$contact_id" method="post" >

<h4>$contact_name</h4>

<label id="crepair-nick-label" for="crepair-nick">$label_nick</label>
<input type="text" id="crepair-nick" name="nick" value="$contact_nick" />
<div class="clear"></div>

<label id="crepair-url-label" for="crepair-url">$label_url</label>
<input type="text" id="crepair-url" name="url" value="$contact_url" />
<div class="clear"></div>

<label id="crepair-request-label" for="crepair-request">$label_request</label>
<input type="text" id="crepair-request" name="request" value="$request" />
<div class="clear"></div>
 
<label id="crepair-confirm-label" for="crepair-confirm">$label_confirm</label>
<input type="text" id="crepair-confirm" name="confirm" value="$confirm" />
<div class="clear"></div>

<label id="crepair-notify-label" for="crepair-notify">$label_notify</label>
<input type="text" id="crepair-notify" name="notify" value="$notify" />
<div class="clear"></div>

<label id="crepair-poll-label" for="crepair-poll">$label_poll</label>
<input type="text" id="crepair-poll" name="poll" value="$poll" />
<div class="clear"></div>

<input type="submit" name="submit" value="$lbl_submit" />

</form>


