<form action='$SELF_URL' METHOD='POST'>
<input type=hidden name='index' value='11'>
<input type=hidden name='UID' value='%UID%'>
<TABLE>
<TR><TD>$_COMPANY:</TD><TD>%COMPANY_NAME%</TD></TR>
<TR><TD>$_TO:</TD><TD>%SEL_COMPANIES%</TD></TR>
</TABLE>
<input type='submit' name='change' value='$_CHANGE'>
</form>
