1 <form accept-charset="utf-8" action="{%url=modules.php?module=login&what=primera&mode=pay%}" method="post">
2 <table border="0" cellspacing="0" cellpadding="0" width="440" class="member_table dashed">
4 <td colspan="3" align="center" class="member_title2 bottom" height="30">
5 <strong>{--PRIMERA_MEMBER_PAYOUT_TITLE--}</strong>
9 <td width="315" class="bottom" height="25" align="right">{--PRIMERA_MEMBER_PAYOUT_POINTS--}</td>
10 <td width="10" class="seperator bottom"> </td>
11 <td width="115" class="bottom"><strong>$content[points]</strong> Primera</td>
14 <td width="315" class="bottom" height="25" align="right">{--PRIMERA_MEMBER_PAYOUT_MIN_POINTS--}</td>
15 <td width="10" class="seperator bottom"> </td>
16 <td width="115" class="bottom"><strong>$content[min_points]</strong> Primera</td>
19 <td colspan="3" height="3" class="seperator"> </td>
22 <td width="315" height="35" align="right">{--PRIMERA_MEMBER_NICKNAME--}</td>
23 <td width="10" class="seperator"> </td>
24 <td width="115"><input type="text" name="primera_nickname" size="10" maxlength="255" value="$content[primera_nickname]" /></td>
27 <td width="315" height="35" align="right">{--PRIMERA_MEMBER_PASSWORD--}</td>
28 <td width="10" class="seperator"> </td>
29 <td width="115"><input type="password" name="primera_password" size="10" maxlength="255" /></td>
32 <td width="315" height="35" align="right">{--PRIMERA_MEMBER_AMOUNT--}</td>
33 <td width="10" class="seperator"> </td>
34 <td width="115"><input type="text" name="amount" size="10" maxlength="255" /></td>
37 <td colspan="3" height="3" class="seperator bottom"> </td>
40 <td colspan="3" align="center" class="member_footer">
41 <input type="reset" class="member_reset" value="{--CLEAR_FORM--}" />
42 <input type="submit" name="ok" class="member_submit" value="{--PRIMERA_MEMBER_PAYOUT_SUBMIT--}" />
48 <div class="member_note"> {--PRIMERA_MEMBER_PAYOUT_NOTE--}</div>