{header_cssjs}
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<script src="/js/datepicker.js" type="text/javascript" charset="UTF-8" language="javascript"></script>
<link rel="stylesheet" href="/css/datepicker.css" type="text/css"/>

    
</head>
<!-- header -->
{header}
<!-- #header -->

<!-- center block -->

<div id="tabs" class="height_tabs"></div>
<table class="content">
<tr class="width100"><td class="spysok_brony"></td>
<td id="blue_zagolovok">
{caption_page_name}
</td>
<td class="td_btn">





</td>
<td class="round2"></td></tr>

<tr class="width100">
<td class="settings_left_fon_tab"></td>
<td colspan="2" class="settings_centert_fon_tab">

</td>
<td class="settings_right_fon_tab"></td>
</tr>

<tr><td class="left_design"></td>
<td class="content_td" colspan="2">
<!-- center block -->

	<h4  style="margin:10px 0; color:#000; font-size:14px;">
		{caption_billing_information_2018} 
    </h4>
<form action="/billing/appex_post" method="POST" class="" >
              
<table class="content_forms">
    <tr><td width="100" class="b">{caption_cardowner}</td><td>    
    <input placeholder="{caption_cardowner}" value="" type="text" name="cardholder" class="forms"  size="50">
    </td></tr>
	<tr><td width="100" class="b">{caption_amount}</td><td>
    <input placeholder="{caption_amount}" value="{balance}" type="text" name="amount" class="forms" size="50">
    </td></tr>
	<tr><td width="100" class="b">{caption_card_data}</td><td>
    <input placeholder="{caption_cardnumber}" value="" id="deposit-newcard"  name="cardnumber" class="forms" type="text"  size="23">
    <input placeholder="MM/YY" value="01/20" type="text" name="exp_date" class="forms"  size="6">
    <input placeholder="CVC" value="***" type="text" name="cvc" class="forms"  size="6">
    </td></tr>	
</table>
<div class="bg_img1"></div>


<div class="mw_footer">

<input type="submit" value="{caption_make_cardpayment}"  class="btn_forms">
<span class="mw_href_2"><a href="/billing/blist/1" class="close">{caption_cancel}</a></span>

<input type="hidden" name="orderid" value="{hotel_id}" class="form-control" />

</div>


</form>

<!-- #center block -->

</td>
<td class="right_design"></td></tr>




<tr><td class="niz_left"></td><td class="niz_center"colspan="2"></td><td class="niz_right"></td></tr>
</table>
<!-- footer -->
{footer}