{include file="header.html"}
{$description}

{if $error}
{foreach from=$error item=e} {$e}
{/foreach}
{/if}
{if $manual_euro_config.state} {/if} {if $manual_euro_config.phone} {/if}
Account Holder Name *
Account Number *
Bank Identifier Code *
Address Info
Street Address
City
#_TPL_CC_INFO_STATE#
ZIP
Country
Phone

{if $payment.amount <= 0} {else} {/if}
{include file="footer.html"}