Name: {Name (First):3.3}{Name (Last):3.6}
Email: {Email:4}
Mailing Address: {Address (Street Address):5.1}, {Address (Address Line 2):5.2} {Address (City):5.3}, {Address (State / Province):5.4} {Address (ZIP / Postal Code):5.5}, {Address (Country):5.6}
Shipping Address: {Shipping Address (if different) (Street Address):6.1},
{Shipping Address (if different) (Address Line 2):6.2}, {Shipping Address (if different) (City):6.3}, {Shipping Address (if different) (State / Province):6.4} {Shipping Address (if different) (ZIP / Postal Code):6.5}, {Shipping Address (if different) (Country):6.6}
Daytime Phone: {Daytime Phone:8}
Alternate Phone: {Alternate Phone:9}