<input type="hidden" name="reporttype" value="custom">
<input type="hidden" name="co_street" value="[% HTML.escape(co_street) %]">
<input type="hidden" name="co_city" value="[% HTML.escape(co_city) %]">
<input type="hidden" name="reporttype" value="custom">
<input type="hidden" name="co_street" value="[% HTML.escape(co_street) %]">
<input type="hidden" name="co_city" value="[% HTML.escape(co_city) %]">