<TMPL_INCLUDE header.html>

<table border="1">

  <TR>
    <td colspan=2 align=center bgcolor=#90c0ff>
      <b>Credit Card Details</b>
    </td>
  </TR>

  <TR>
    <TD align=right bgcolor=#efefef>
      <TMPL_IF error_p_cc_type>
        <font color=red><blink>*</blink></font>
      </TMPL_IF> Card Type:
    </TD>
    
    <TD>
	<select name="p_cc_type">
	<TMPL_IF p_cc_type>
	  <option value="<TMPL_VAR p_cc_type>" selected><TMPL_VAR p_cc_type>
	</TMPL_IF>
	  <option value="">Please Select a Credit Card Type
	  <option value="visa">Visa
	  <option value="mastercard">MasterCard
	  <option value="amex">American Express
	  <option value="discover">Discover
	</select>
    </TD>
  </TR>

  <TR>
    <TD align=right bgcolor=#efefef>
      <TMPL_IF error_p_cc_num>
        <font color=red><blink>*</blink></font>
      </TMPL_IF>Credit Card Number:
    </TD>
    
    <TD>
      <input type="text" name="p_cc_num" value="<TMPL_VAR p_cc_num>" size=20 maxlength=19>
    </TD>
  </TR>

  <TR>
    <TD align=right bgcolor=#efefef>
      <TMPL_IF error_p_cc_exp>
        <font color=red><blink>*</blink></font>
      </TMPL_IF> Expiry Date (MM/YY):
    </TD>
    <TD>
	<select name="p_cc_exp_month" size=1>
	  <TMPL_VAR  p_cc_exp_month_list>	
	</select>&nbsp;
	<select name="p_cc_exp_year" size=1>
	  <TMPL_VAR  p_cc_exp_year_list>
	</select>
    </TD>
  </TR>

  <TR>
    <input type="hidden" name="action" value="verify_order">  
    <TD align=center><input type="submit" name="back" value=" Back "></TD>
    <TD align=center><input type="submit" value=" Verify Order "></TD>
  </TR>

</table>
<TMPL_INCLUDE footer.html>


