<p class="sub_form_address">

{% if form.address_from %}
    {{ form.address_from.error }}{{ form.address_to.error }}
    Date Effective
    {{ form.address_from }} to {{ form.address_to }}<br />
{% endif %}

{{ form.first_name.errors }}{{ form.last_name.errors }}
First/Last Name{% if form.first_name.field.required %}<span class="required">*</span>{% endif %}
{{ form.first_name }} {{ form.last_name }}<br />

{{ form.company.errors }}
Company
{{ form.company }}<br />

{{ form.address.errors }}
Address{% if form.address1.field.required %}<span class="required">*</span>{% endif %}
{{ form.address1 }}<br />
{{ form.address2 }}<br />

{{ form.city.errors }}
City{% if form.city.field.required %}<span class="required">*</span>{% endif %}
{{ form.city }}<br />

{{ form.region.errors }}
State/Province{% if form.region.field.required %}<span class="required">*</span>{% endif %}
{{ form.region }}<br />

{{ form.country.errors }}
Country{% if form.country.field.required %}<span class="required">*</span>{% endif %}
{{ form.country }}<br />

{{ form.country_other.errors }}
Other <span class="fine_print">(Foreign only) </span>
{{ form.country_other}}<br />

{{ form.postal_code.errors }}{{form.plus_four.errors }}
ZIP+4{% if form.postal_code.field.required %}<span class="required">*</span>{% endif %}
{{ form.postal_code }}-{{ form.plus_four }}<br />

{{ form.phone.errors }}
Phone{% if form.phone.field.required %}<span class="required">*</span>{% endif %}
{{ form.phone }}<br />

{% if show_email_field %}
    {{ form.email.errors}}
    E-mail{% if form.email.field.required %}<span class="required">*</span>{% endif %}
    {{ form.email }}<br />
{% endif %}

</p>