  <div id="content">    
   <div id="terms">
      <h2>Terms and Conditions</h2>
      __terms__
</div>
   
   <div id="apptinfo">
   <h2>Appointment Info</h2>
   <!-- start location info -->
   <p><strong>APPOINTMENT LOCATION</strong><br />
   __LOCATION_address1__<br />
    __LOCATION_city_state_zip__<br />
   __LOCATION_phone__</p>
   <!-- end location info -->
   <p><strong>APPOINTMENT DETAILS</strong><br />
   __date__ __time__<br />
   Services: __service__ <br />
   Stylist: __stylist__</p>
   </div>
   
   <div id="contactinfo">
   <form action="verify.php" method="post">
   <h2>Contact Info</h2>
 
   <table width="500" border="0" cellspacing="0" cellpadding="0">
  <tr>
    <td><label for="firstname">First Name:</label></td>
    <td><input type="text" name="firstname" id="firstname" value="__firstname__" /></td>
    <td>&nbsp;</td>
    <td> <label for="email">Email:</label></td>
    <td> <input type="text" name="email" id="email" value="__email__" /></td>
  </tr>
  <tr>
    <td><label for="lastname">Last Name:</label></td>
    <td><input type="text" name="lastname" id="lastname" value="__lastname__" /></td>
    <td>&nbsp;</td>
    <td><label for="phone1">Phone:</label></td>
    <td><input type="text" name="phone1" id="phone1" value="__phone1__" /></td>
  </tr>
  <tr>
    <td>&nbsp;</td>
    <td>&nbsp;</td>
    <td>&nbsp;</td>
    <td>&nbsp;</td>
    <td>&nbsp;</td>
  </tr>
  
</table>
   
   
   <table width="500" border="0" cellspacing="0" cellpadding="0">
 <tr>
    <td width="30"><input type="checkbox" name="verified" id="verified" value="verified" /></td>
    <td width="470" colspan="4"><label for="verified">I confirm that my appointment and contact info are correct, and that I have read the cancellation policy.</label></td>
    </tr>
</table>
  
 
   
   <input type="hidden" name="id" id="id" value="__id__" />
   <br/>
   <input type="submit" name="verify_submit" id="verify_submit" value="Confirm" />
   </form>
   </div>
   </div>
   <div class="clear"></div>
   </div>
   </body>
   </html>