<form action="register.php" method="post" name="registeruser" id="registeruser">
                            <div id="geninfo">
                                <p><label for="name">Full Name:<span class="important">*</span></label><input type="text" name="name" class="required" /></p>
                                <p><label for="username">Username:<span class="important">*</span></label><input id="username" type="text" name="username" class="required" /></p>
                                <p><label for="password">Password:<span class="important">*</span></label><input id="password" type="password" name="password" class="required" /></p>
                                <p><label for="cpassword">Confirm Password:<span class="important">*</span></label><input id="cpassword" type="password" name="cpassword" class="required" /></p>
                                <p><label for="email">E-Mail Address:<span class="important">*</span></label><input id="email" type="text" name="email" class="required email" /></p>
                                <p><label for="phone">Phone:<span class="important">*</span></label><input type="text" name="phone" class="required" /></p>
                                <p><label for="mobile">Mobile:</label><input type="text" name="mobile" /></p>
                                <p><label for="fax">Fax:</label><input type="text" name="fax" /></p>
                                <p><label for="agent">Type of User</label><input class="usertype" type="radio" name="usertype" value="Agent" /><span class="usertype">Agent</span><input class="usertype" type="radio" name="usertype" value="Interior Decorator" /><span class="usertype">Interior Decorator</span><input class="usertype" type="radio" name="usertype" value="Normal" /><span class="usertype">Normal</span></p>
                            </div>
                            <div id="agentinfo">
                                <h1>Agent/Interior Decorator Information</h1>
                                <p><label for="agentcity">Select City:<span class="important">*</span></label><select name="agentcity"><option value="">-</option></select><img class="loading" src="images/loading.gif" /></p>
                                <p><label for="companyname">Company Title:<span class="important">*</span></label><input type=text name="companyname" /></p>
                                <p><label for="companyaddress">Address:<span class="important">*</span></label><input type=text name="companyaddress" /></p>
                                <p><label for="companydes">Description:</label><textarea rows="5" cols="15" name="companydes"></textarea></p>
                                <p><label for="companyweb">Website:</label><input type=text name="companyweb" /></p>
                            </div>
                            <h1>Human Verification</h1>
                            <div id="bothcells"><p style="height:30px;"><img id="captcha" src="includes/secureimage/securimage_show.php" alt="CAPTCHA Image" />
                            <a tabindex="-1" style="border-style: none; margin-left:5px;" href="#" title="Refresh Image" onclick="document.getElementById('captcha').src = 'includes/secureimage/securimage_show.php?sid=' + Math.random(); return false"><img src="images/refresh.png" alt="Reload Image" onclick="this.blur()" style="vertical-align: top; border:0;" /></a></p></div>
                            <p><label for="seccode">Verification Code:<span class="important">*</span></label><input id="seccode" type="text" name="seccode" size="10" class="required" /></p>
                            <div id="bothcells"><p><input type="submit" value="Register" name="register" class="submitbtn" /></p></div>
                        </form>