<?xml version="1.0" encoding="utf-8"?>
<form>
	<fieldset>
		<field 
			name="email_id" type="hidden" default="0" 
			label="JGLOBAL_FIELD_ID_LABEL" 
		/>
		<field
			name="form_id"
			 type="hidden"
			label="JGLOBAL_TITLE"
			description="JFIELD_FORM_ID"
			class="inputbox"
			size="110"
			/>
			<field
			name="user_id"
			 type="hidden"
			label="JGLOBAL_TITLE"
			description="JFIELD_USER_ID"
			class="inputbox"
			size="110"
			/>
		<field
			name="email_name"
			type="text"
			label="JSN_UNIFORM_EMAIL_NAME"
			description="JSN_UNIFORM_EMAIL_NAME_DES"
			class="inputbox"
			size="40"/>
			<field
			name="email_address"
			type="text"
			label="JSN_UNIFORM_EMAIL_ADDRESS"
			description="JSN_UNIFORM_EMAIL_ADDRESS_DES"
			class="inputbox"
			size="40"/>
			<field
			name="email_state"
			type="text"
			label="JSN_UNIFORM_EMAIL_STATE"
			description="JSN_UNIFORM_EMAIL_STATE_DES"
			class="inputbox"
			size="40"/>
		
	</fieldset>
        
</form>
