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    	#end
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    	#end
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    	<div class="row">
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    	<div class="row">
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        	<div class="text">Recharge Type : </div>
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        	<div class="text">Recharge Type : </div>
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        	<div style="0 0 0 10px;">
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        	<div style="0 0 0 10px;">
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    			<input class='rechargetype' type="radio" checked name="rechargeType" value="1">Normal</input>
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    			<input class='rechargetype' type="radio" checked name="rechargeType" value="1">Normal</input>
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    			<input class='rechargetype' type="radio" name="rechargeType" value="2">New Connection</input>
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    			<input class='rechargetype' type="radio" name="rechargeType" value="2">New Connection (FRC)</input>
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    		</div>
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    		</div>
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        </div>
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        </div>
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    	<div class="row">
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    	<div class="row">
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        	<div class="text">Device Type : </div>
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        	<div class="text">Device Type : </div>
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            	<div class="input-div">
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            	<div class="input-div">
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        			<input class='inputbox padding15' type='text' name='altNum'></input>
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        			<input class='inputbox padding15' type='text' name='altNum'></input>
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        		</div>
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        		</div>
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    		</div>
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    		</div>
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    	</div>
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    	</div>
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		<div class="row">
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        	<div class="text">Pay method : </div>
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        	<div>
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        		<input class='payMethod' type="radio" checked="checked" name="payMethod" value="1">Cash</input>
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        		<input class='payMethod' type="radio" name="payMethod" value="2">Card</input>
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    		</div>
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		</div>
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		<input type='hidden' name='circlecode' id='circlecode' />
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		<input type='hidden' name='circlecode' id='circlecode' />
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    	<div class="row">
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    	<div class="row">
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        	<div style="padding-top:10px;margin-top: 25px;padding-left: 200px;">
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        	<div style="padding-top:10px;margin-top: 25px;padding-left: 200px;">
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    			<input type="submit" value='submit' style="height: 30px;background-color: orange;cursor: pointer;width: 140px;font-size: 21px;">
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    			<input type="submit" value='submit' style="height: 30px;background-color: orange;cursor: pointer;width: 140px;font-size: 21px;">