<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="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 tables="products shipping"]
my $options = '';
for my $zone_group (@{$Tag->query({sql => "SELECT zone_group FROM cpa GROUP BY zone_group ORDER BY zone_group"})}) {
$options .= qq(
												<optgroup label="$zone_group->[0]">);
	for my $zone (@{$Tag->query({sql => "SELECT zone FROM cpa WHERE zone_group='$zone_group->[0]'"})}) {
		$options .= qq(
													<option value="$zone->[0]") . ($zone->[0] eq $Tag->value({keep => 1, filter => encode_entities, name => city}) ? ' selected' : '') . ">$zone->[0]</option>";
	}
	$options .= q(
												</optgroup>);
}
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>