print "<form method='post' action='mailto:someone\@somewhere.com'>";
	 print "<input type='hidden' name='CustomerNumber' value='$CustomerNumber'>";
	 print "<input type='hidden' name='Name' value='$Name'>";
	 print "<input type='hidden' name='Address1' value='$Address1'>";
	 print "<input type='hidden' name='City' value='$City'>";
	 print "<input type='hidden' name='State' value='$State'>";
	 print "<input type='hidden' name='ZipCode' value='$ZipCode'>";
	 print "<input type='hidden' name='Email' value='$Email'>";
         print "<center><input type='image' name='submit_change_password' src='/images/graphics/change-password-button.jpg'>";
	 print "</center></form>";