<table width="100%" border="0" cellpadding="0" cellspacing="0">
  <tr>
    <td background="<?php echo $this->basedir;?>templates/member/images/list_title_bg.gif"><img src="<?php echo $this->basedir;?>templates/member/images/chkcar_title.gif" width="759" height="50" /></td>
  </tr>
  <tr>
    <td background="<?php echo $this->basedir;?>templates/member/images/title_line_bg.gif">&nbsp;</td>
  </tr>
  <tr>
    <td>
	<form id="form1" name="form1" method="post" action="">
	<table width="431" border="0" align="center" cellpadding="4" cellspacing="0">
	<tr><td colspan="2" align="center"><?php echo $this->message;?></td></tr>
      <tr>
        <td align="right">登录名：</td>
        <td><input name="username" type="text" value="<?php echo $this->user['username'];?>" />
          *请填写需要充值的帐户</td>
      </tr>
      <tr>
        <td width="94" align="right">充值卡号：</td>
        <td width="490"><input type="text" name="carid" />
          *</td>
      </tr>
      <tr>
        <td align="right">充值密码：</td>
        <td><input type="text" name="carpwd" />
          *</td>
      </tr>

      <tr>
        <td align="right">&nbsp;</td>
        <td>
          <input type="submit" name="Submit" value=" 充 值 " />        </td>
      </tr>
    </table>
	</form></td>
  </tr>
  <tr>
    <td background="<?php echo $this->basedir;?>templates/member/images/title_line_bg.gif" height="15"></td>
  </tr>
</table>
