<STRONG><%REF_NAME/h%></STRONG><BR>
<TABLE>
<TR>
  <TD>Payment Type:</TD>
  <TD><%METHOD/h%></TD>
</TR>
<TR>
  <TD>Name:</TD>
  <TD><%NAME/h%><BR>
</TR>
<TR>
  <TD>Number:</TD>
  <TD>XXXXXXXXXXXXXXXX</TD>
</TR>
<TR VALIGN="BASELINE">
  <TD>Address:</TD>
  <TD>
  <%Condition
    c.arg="LINE_1"
    c.template="<%LINE_1/f%><BR>"
    default.template={<SPAN STYLE="color: #880000">Wrong address</SPAN>}
  %>
  <%Condition
    c.arg="LINE_2"
    c.template="<%LINE_2/f%><BR>"
  %>
  <%CITY/h%>, <%STATE/h%> <%ZIPCODE/h%>
  </TD>
</TR>
<TR>
  <TD>Phone:</TD>
  <TD><%PHONE/h%></TD>
</TR>
</TABLE>