<form action="index.php?site=report" name="report_$type_$id" method="post">
<input type="hidden" name="mode" value="$mode">
<input type="hidden" name="type" value="$type">
<input type="hidden" name="id" value="$id">
<input type="hidden" name="referer" value="$referer">
<table width="100%" border="0" cellspacing="1" cellpadding="2" bgcolor="$border">
	<tr>
		<td align="center" class="title" colspan="3">report dead or broken link </td>
  </tr>
  <tr> 
    <td bgcolor="$pagebg"></td>
  </tr>
	<tr>
		<td bgcolor="$bg1">If the file-url is broken, and you know why, leave a fixed url and a short description in this field:</td>
	</tr>
	<tr>
	  <td bgcolor="$bg2" align="center"><textarea name="description" cols="60" rows="5" class="form_off" onFocus="this.className='form_on'" onBlur="this.className='form_off'"></textarea>
<br>$captcha_form</td>
	</tr>
	<tr>
		<td bgcolor="$bg1" align="center"><input type="submit" name="confirm" value="report"> <input type="reset" name="reset" value="reset"></td>
	</tr>
</table>
<br>
</form>