1 [% PROCESS "header.tt" title =
> "Account Information" %]
3 <span style=
"color:green">Congratulations! The test domain
<b>[% domain %]
</b> is available.
</span><br>
5 Please enter your account information.
6 <form name=[% form_name %] action=[% script_name %] method=post
>
7 <input type=hidden name=domain
>
11 <td><label>First Name:
</label></td>
12 <td><input type=text name=first_name
></td>
13 <td><span class=error id=first_name_error
>[% first_name_error %]
</span></td>
16 <td><label>Last Name:
</label></td>
17 <td><input type=text name=last_name
></td>
18 <td><span class=error id=last_name_error
>[% last_name_error %]
</span></td>
21 <td><label>Country:
</label></td>
24 <option value=
"">Choose country
</option>
25 [%- FOR code IN countries.keys.sort %]
26 <option value=
"[% code %]">[% countries.$code %]
</option>
30 <td><span class=error id=country_error
>[% country_error %]
</span></td>
33 <td><label>Password:
</label></td>
34 <td><input type=text name=password
></td>
35 <td><span class=error id=password_error
>[% password_error %]
</span></td>
38 <td><label>Password
<br>Verify:
</label></td>
39 <td><input type=text name=password2
></td>
40 <td><span class=error id=password2_error
>[% password2_error %]
</span></td>
44 <td colspan=
2 align=right
>
45 <input type=submit
value=
"Bill me"><br>
54 [% PROCESS "footer.tt" %]