{header}
<table width="100%" border="0" cellpadding="2" cellspacing="6">
  <tr>
    <td><br />
      <form action="{url_page}" method="POST">
        <input type="hidden" name="cmd" value="update">
        <!-- begin_pay -->
        <table width="100%" border="0" cellpadding="0" cellspacing="0" class="tableborder">
          <tr class="header">
            <td colspan="2">{payment}:</td>
          </tr>
          <!-- begin_field -->
          <tr>
            <!-- begin_text -->
            <td width="60%" class="altbg1" >{l_field}:</td>
            <td class="altbg2"><input type="text" name="{key}" value="{value}" style="width: 250px;"></td>
            <!-- end_text -->
            <!-- begin_check -->
            <td width="60%" class="altbg1" >{l_field}:</td>
            <td class="altbg2"><input type="checkbox" name="{key}" value="Y" {value}></td>
            <!-- end_check -->
          </tr>
          <!-- end_field -->
        </table>
        <center>
          <input class="button" type="submit" value="{l_modify}">
        </center>
        <!-- end_pay -->
      </form></td>
  </tr>
</table>
{footer}