<%set star='*'%> <%if modify%><%endif%> <%if billing_phone_required%> <%endif%>

<%body_font%> Please enter your credit card and billing information in the fields below. Fields marked with <%star%> are required. <%if payment_declined%> Your payment was declined: <%payment_errmsg%> <%elsif payment_erred%> An error occured while processing your payment: <%payment_errmsg%> <%elsif error%> <%error%> <%endif%>
<%body_font%> <%if no_cc_brand%>Cards Accepted<%else%><%if credit_card_brand_error%><%endif%>Card Type<%if credit_card_brand_error%>:<%endif%> <%star%><%endif%>	<%if no_cc_brand%> <%body_font%><%loop payment_types%><%unless first%>, <%endunless%><%name%><%endloop%> <%else%> <%endif%>
<%body_font%> <%if credit_card_number_error%><%endif%>Card Number:<%if credit_card_number_error%><%endif%> <%star%>	value="<%credit_card_number%>"<%endif%>>
<%body_font%> <%if credit_card_expiry_error%><%endif%>Expiry:<%if credit_card_expiry_error%><%endif%> <%star%>	/ <%Links::Payment::next_years(10)%><%-- Show the next 10 years --%>
<%body_font%> <%if billing_fname_error%><%endif%>Billing First Name:<%if billing_fname_error%><%endif%> <%star%>	value="<%billing_fname%>"<%endif%>>
<%body_font%> <%if billing_lname_error%><%endif%>Billing Last Name:<%if billing_lname_error%><%endif%> <%star%>	value="<%billing_lname%>"<%endif%>>
<%body_font%> <%if billing_address_1_error%><%endif%>Billing Address Line 1:<%if billing_address_1_error%><%endif%> <%star%>	value="<%billing_address_1%>"<%endif%>>
<%body_font%> <%if billing_address_2_error%><%endif%>Billing Address Line 2:<%if billing_address_2_error%><%endif%>	value="<%billing_address_2%>"<%endif%>>
<%body_font%> <%if billing_city_error%><%endif%>Billing City:<%if billing_city_error%><%endif%> <%star%>	value="<%billing_city%>"<%endif%>>
<%body_font%> <%if billing_state_error%><%endif%>Billing State/Province:<%if billing_state_error%><%endif%> <%star%>	value="<%billing_state%>"<%endif%>>
<%body_font%> <%if billing_country_error%><%endif%>Billing Country:<%if billing_country_error%><%endif%> <%star%>	value="<%billing_country%>"<%endif%>>
<%body_font%> <%if billing_postal_code_error%><%endif%>Billing Postal/Zip Code:<%if billing_postal_error%><%endif%> <%star%>	value="<%billing_postal_code%>"<%endif%>>
<%body_font%> <%if billing_phone_error%><%endif%>Billing Phone:<%if billing_phone_error%><%endif%> <%star%>	value="<%billing_phone%>"<%endif%>>