<script type="text/javascript" language="JavaScript">
//<![CDATA[
function validateAndSubmit(form)
{
	if (checkString(form.elements["number"], "{TXT_NUMBER}")) {
		return form.submit();
	}
	return false;
}
//]]>
</script>
        <form method="post" action="{VAL_FORMACTION}">
<div class="card">
<div class="card-header">
<div class="card-title h5">
{TXT_DESCRIPTION}
</div>
</div>
<div class="card-body">
<div class="form-group">
<img class="img-responsive" src="/share/img/sendcard.png" border="0px" alt="" />
<label class="form-label" for="number">
{TXT_NUMBER}&nbsp;*
</label>
<input class="form-input" type="tel" name="number" value="" required placeholder="{TXT_NUMBER}" />
<input class="form-input" type="file" name="file" placeholder="{TXT_UPLOAD_FILE}" />
</div>
</div>
<div class="card-footer">
<div class="btn-group btn-group-block">
<input class="btn btn-primary" type="button" onclick="javascript: return validateAndSubmit(this.form);" value="{TXT_ACTION}" />
</div>
</div>
</div>

	{HIDDEN_VARS}
        </form>
