<patTemplate:tmpl name="pageoutput">
<script language="JavaScript" src="{LIVESITE}/includes/js/joomla.javascript.js" type="text/javascript"></script>
{JOMRESJS}
<div id='jomresmenu_hint' style='color:red' >&nbsp;</div>
<form action="index.php?option=com_jomres" method="post" name="adminForm">
<table class="jradmin_innerwrapper">
	<tr>
		<td class="jomres_title">{PAGETITLE}</td>
	</tr>
	<tr>
		<td>{JOMRESTOOLBAR}</td>
	</tr>
	<tr>
		<td>
			<table class="jradmin_table">
				<tr>
					<td class="jradmin_subheader_la">{HCCARDNO}</th>
					<td class="jradmin_field_la"><input type="text" class="inputbox" size="16" name="ccard_no" value="{CCARDNO}"></td></tr>
				<tr>
					<td class="jradmin_subheader_la">{HCCARDNAME}</td>
					<td class="jradmin_field_la"><input type="text" class="inputbox" size="20" name="ccard_name" value="{CCARDNAME}"></td>
				</tr>
				<tr>
					<td class="jradmin_subheader_la">{HCCARDISS}</td>
					<td class="jradmin_field_la">{CCARDISS}</td>
				</tr>
				<tr>
					<td class="jradmin_subheader_la">{HCCARDEXPIRE}</td>
					<td class="jradmin_field_la">{CCARDEXPIRE}</td>
				</tr>
				<tr>
					<td class="jradmin_subheader_la">{HCCARISSNO}</td>
					<td class="jradmin_field_la">{CCARISSNO}</td>
				</tr>
				<tr>
					<td class="jradmin_subheader_la">{HCCV}</td>
					<td class="jradmin_field_la"><input type="text" class="inputbox" size="4" name="ccv" value="{CCV}"></td>
				</tr>
			</table>
			<table border="0" class="popup_blank">
				
				<tr>
					<td>{CCARDTYPE}</td>
				</tr>
			</table>
		</td>
	</tr>
</table>
{JOMRESTOKEN}
<input type="hidden" name="guestUid" value="{GUESTUID}" />
<input type="hidden" name="Itemid" value="{ITEMID}" />
<input type="hidden" name="task" value="saveCreditcard" />
</form>
</patTemplate:tmpl>