<form action='$SELF_URL' METHOD='POST'>
<input type=hidden name='index' value='$index'>
<input type=hidden name=COMPANY_ID value='%COMPANY_ID%'>
<TABLE width='420' cellspacing='0' cellpadding='3'>
%EXDATA%
<TR><TD colspan=2>&nbsp;</TD></TR>

<TR><TD>$_CREDIT:</TD><TD><input type=text name='CREDIT' value='%CREDIT%' size=8> 
$_DATE: <input type=text name='CREDIT_DATE' value='%CREDIT_DATE%' size=10>
</TD></TR>
<TR><TD>$_GROUPS:</TD><TD>%GID%:%G_NAME%</TD></TR>
<TR><TD>$_ACTIVATE:</TD><TD><input type=text name=ACTIVATE value='%ACTIVATE%'></TD></TR>
<TR><TD>$_EXPIRE:</TD><TD><input type=text name=EXPIRE value='%EXPIRE%'></TD></TR>
<TR><TD>$_REDUCTION (%):</TD><TD><input type=text name=REDUCTION value='%REDUCTION%'></TD></TR>
<TR><TD>$_DISABLE:</TD><TD><input type=checkbox name=DISABLE value='1' %DISABLE%> %DISABLE_MARK%</TD></TR>
<TR><TD>$_REGISTRATION</TD><TD>%REGISTRATION%</TD></TR>
<TR><td colspan='2'>%PASSWORD%</TD></TR>
</TABLE>
<input type=submit name='%ACTION%' value='%LNG_ACTION%'>
</form>
