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<!--
Released under the GNU General Public License (Version 2)
[http://www.gnu.org/licenses/gpl-2.0.html]
-->
<form name='heidelpay' class='module_option_checked' action='{$formUrl}' method='post' onsubmit='return valGatewayForm();' autocomplete='off'>
<table class="newreg_{$pm}">
<colgroup>
<col width="145">
<col width="165">
</colgroup>
<tr>
<td><label>{$smarty.const.HGW_TXT_MAIL}*:</label></td>
<td><input type="text" class="text" value="" id="cardVerification" name="CONTACT.EMAIL" /></td>
</tr>
<tr>
<td colspan='2' class="description">{$smarty.const.HGW_TXT_MAND}</td>
</tr>
</table>
{if $DbOnRg}<input type="hidden" name='CRITERION.DBONRG' value='{$DbOnRg}' />{/if}
<br/><br/>
<input type="button" value="{$smarty.const.HGW_BTN_CANCEL}" class="grey button left" onClick="location.href='ext/heidelpay/heidelpayGW_response.php?cancel=1'" />
<input type="submit" value="{$smarty.const.HGW_BTN_CONTINUE}" class="green button right" />
</form>