custedit-wbroker.html

<#header>

        <h1>Edit Customer Information</h1>
        <form id="customerForm">
            <div class="form-group">
                <label for="company">Company:</label>
                <input type="text" id="company" name="company" value="<#Company>" required>
            </div>

            <div class="form-group">
                <label for="firstName">Name:</label>
                <div class="input-group">
                    <input type="text" id="firstName" name="firstName" value="<#FirstName>" placeholder="First Name" required>
                    <input type="text" id="lastName" name="lastName" value="<#LastName>" placeholder="Last Name" required>
                </div>
            </div>

            <div class="form-group">
                <label for="Address">Address:</label>
                <input type="text" id="Address" name="Address" value="<#Address>" placeholder="Address" required>
            </div>

            <div class="form-group">
                <label for="city">Location:</label>
                <div class="input-group">
                    <input type="text" id="city" name="city" value="<#City>" placeholder="City" required>
                    <input type="text" id="state" name="state" value="<#State>" placeholder="State" required>
                    <input type="text" id="zip" name="zip" value="<#Zip>" placeholder="Zip" required>
                </div>
            </div>

            <div class="form-group">
                <label for="email">Email:</label>
                <input type="email" id="email" name="email" value="<#Email>" required>
            </div>

            <div class="form-group">
                <label for="Phone">Phone:</label>
                <input type="tel" id="Phone" name="Phone" value="<#Phone>">
            </div>

            <button type="submit">Submit</button>
        </form>

<#footer>