<form action="{FORMACTION}" method="post">
	<table class="std" width="40%">
	  <tr class="tbltitle">
		<td colspan="2">
		  <table class="fullwidth_invisible" cellspacing="0">
			<tr class="tbltitle">
			  <td width="10"><img src="{TYPE_IMG}" alt="{ALT_IMG}" title="{ALT_IMG}" border="0" vspace="0" align="left" /></td>
			  <td class="tbltitle" align="left">&nbsp;{TITLE}</td>
			</tr>
		  </table>
		</td>
	  </tr>
	  <tr>
		<td class="option">{TXT_OBJECT}</td>
		<td class="option_value">{OBJECT}</td>
	  </tr>
	  <tr>
		<td class="option">{TXT_TRANSACTION}</td>
		<td class="option_value"><input type="text" name="transaction" value="{TRANSACTION}" maxlength="25"></td>
	  </tr>
	  <tr>
		<td class="option">{TXT_VENDOR}</td>
		<td class="option_value">{VENDOR}</td>
	  </tr>
	  <tr>
		<td class="option">{TXT_PAY_METHOD}*</td>
		<td class="option_value">
			<select name="pay_method" size="1">
				<option value=""></option>
				<option value="1"{PAY_METHOD_1}>{TXT_PAY_METHOD_BILL}</option>
				<option value="2"{PAY_METHOD_2}>{TXT_PAY_METHOD_BMF}</option>
				<option value="3"{PAY_METHOD_3}>{TXT_PAY_METHOD_PAYPAL}</option>
			</select>
		</td>
	  </tr>
	  <tr>
		<td class="option" >{TXT_ORDER_DATE}</td>
		<td class="option_value">{ORDER_DATE}</td>
	  </tr>
	  <tr>
		<td class="option">{TXT_DURATION}*</td>
		<td class="option_value">
			<select name="duration" size="1">
				<option value=""></option>
<!-- BEGIN duration_loop -->
				<option value="{DURATION_LOOP_ID}"{DURATION_LOOP_SELECTED}>{DURATION_LOOP_NAME}</option>
<!-- END duration_loop -->
			</select>
		</td>
	  </tr>
	  <tr>
		<td class="option">{TXT_PAYED}</td>
		<td class="option_value">
			<select name="payed" size="1">
				<option value="0">{TXT_NO}</option>
				<option value="1"{PAYED_1}>{TXT_YES}</option>
			</select>
		</td>
	  </tr>
	  <tr>
		<td class="option">{TXT_ACCESS}</td>
		<td class="option_value">
			<select name="access" size="1">
				<option value="0">{TXT_NO}</option>
				<option value="1"{ACCESS_1}>{TXT_YES}</option>
			</select>
		</td>
	  </tr>
	  <tr class="tblfooter" >
		<td class="submit" colspan="2">
			<input class="submit" type="submit" name="cmd[saveCustomer]" value="{TXT_SAVE}" />
			<input class="submit" type="submit" name="cmd[{STATISTICS}]" value="{TXT_CANCEL}" /></td>
	  </tr>
	</table>
</form>