<input type="hidden" name="reporttype" value="custom">
<input type="hidden" name="co_street" value="<TMPL_VAR co_street>">
<input type="hidden" name="co_city" value="<TMPL_VAR co_city>">
<input type="hidden" name="reporttype" value="custom">
<input type="hidden" name="co_street" value="<TMPL_VAR co_street>">
<input type="hidden" name="co_city" value="<TMPL_VAR co_city>">