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Rev 21101 Rev 21363
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	<label for="amount">Amount:</label>
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	<label for="amount">Amount:</label>
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    <input id="amount" name="amount" />
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    <input id="amount" name="amount" />
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	<label for="email">Email:</label>
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	<label for="email">Email:</label>
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	<input id="email" name="email" value="$user.getEmail()" readonly/>
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	<input id="email" name="email" value="$user.getEmail()" readonly/>
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	<label for="email">CashBack:</label>
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	<label for="email">CashBack:</label>
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    <input name="cashback" value="1%" readonly/>
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	<select name="cashback">
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		<option value="0">0%</option>
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		<option value="1">1%</option>
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	</select>
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	<button type="submit" style="margin:5px;">Submit</button>
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	<button type="submit" style="margin:5px;">Submit</button>
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	</form>
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	</form>
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#end
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#end
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</body>
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</body>
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<script type="text/javascript">
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<script type="text/javascript">