<div class="row g-4">
										<div class="form-group col-md-12">
											<label class="form-label" for="firstname">[L]First Name[/L]</label>
											<input class="form-control" type="text" name="fname" placeholder="Joe" id="firstname" value="[evalue fname]"/>
										</div>
										<div class="form-group col-md-12">
											<label class="form-label" for="lastname">[L]Last Name[/L]</label>
											<input class="form-control" type="text" name="lname" placeholder="Biden" id="lastname" value="[evalue lname]"/>
										</div>
										<div class="form-group col-md-12">
											<label class="form-label" for="emailaddress_shipping">[L]Email Address[/L]</label>
											<input class="form-control" type="text" name="email" placeholder="joe.black@gmail.com" id="emailaddress_shipping" value="[evalue email]"/>
										</div>
										<div class="form-group col-md-12">
											<label class="form-label" for="street_shipping">[L]Street[/L]</label>
											<input class="form-control" type="text" name="address1" placeholder="123 Main St." id="street_shipping" value="[evalue address1]"/>
										</div>
										<div class="form-group col-md-8">
											<label class="form-label" for="province_shipping">[L]Province[/L]</label>
											<select name="state" id="province_shipping" class="form-control" onchange="this.form.submit()">
												<option value="-- [L]Please select[/L] --">-- [L]Please select[/L] --</option>[perl products]
my $options = '';
for my $province (@{$Tag->query({sql => "SELECT province FROM shipping GROUP BY province ORDER BY province"})}) {
				$options .= qq(
												<option value="$province->[0]") . ($province->[0] eq $Tag->value({keep => 1, filter => encode_entities, name => 'state'}) ? ' selected' : '') . ">$province->[0]</option>";
}
return $options;
[/perl]
											</select>
										</div>
										<div class="form-group col-md-8">
											<label class="form-label" for="city_shipping">[L]City[/L]</label>
											<select name="city" id="city_shipping" class="form-control" onchange="this.form.submit()">
												<option value="-- [L]Please select[/L] --">-- [L]Please select[/L] --</option>[perl products]
my $options = '';
for my $city (@{$Tag->query({sql => "SELECT city FROM shipping WHERE province='" . $Tag->value({keep => 1, filter => encode_entities, name => 'state'}) . "' GROUP BY city ORDER BY city"})}) {
				$options .= qq(
												<option value="$city->[0]") . ($city->[0] eq $Tag->value({keep => 1, filter => encode_entities, name => 'city'}) ? ' selected' : '') . ">$city->[0]</option>";
}
return $options;
[/perl]
											</select>
										</div>
										<div class="form-group col-md-8">
											<label class="form-label" for="district_shipping">[L]District[/L]</label>
											<select name="address3" id="district_shipping" class="form-control" onchange="this.form.submit()">
												<option value="-- [L]Please select[/L] --">-- [L]Please select[/L] --</option>[perl products]
my $options = '';
for my $district (@{$Tag->query({sql => "SELECT district FROM shipping WHERE city='" . $Tag->value({keep => 1, filter => encode_entities, name => 'city'}) . "' GROUP BY district ORDER BY district"})}) {
				$options .= qq(
												<option value="$district->[0]") . ($district->[0] eq $Tag->value({keep => 1, filter => encode_entities, name => 'address3'}) ? ' selected' : '') . ">$district->[0]</option>";
}
return $options;
[/perl]
											</select>
										</div>
										<div class="form-group col-md-4">
											<label class="form-label" for="zip_shipping">[L]ZIP[/L]</label>
											<input class="form-control" type="text" name="zip" placeholder="Postal code" id="zip_shipping" value="[evalue zip]"/>
										</div>
										<!--div class="form-group">
											<label class="form-label" for="state_shipping">[L]State[/L]</label>
											<input class="form-control" type="text" name="state" placeholder="State" id="state_shipping" value="[evalue state]"/>
										</div-->
										<input type="hidden" name="country" value="__SHIP_DEFAULT_COUNTRY__"/>
										<div class="form-group col-md-12">
											<label class="form-label" for="phonenumber_shipping">[L]Phone Number[/L]</label>
											<input class="form-control" type="text" name="phone_day" placeholder="Phone Number" id="phonenumber_shipping" value="[evalue phone_day]"/>
										</div>
									</div>