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<div class="center-text-bold12">Please enter the words shown below:</div><br/>
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<div class="center-text-bold12">Please enter the words shown below:</div><br/>
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<form id="codSelection" name="codSelection" action="/order" method="post" onsubmit="return verifyCodSelectionForm('codSelection')">
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<form id="codSelection" name="codSelection" action="/order" method="post" onsubmit="return verifyCodSelectionForm('codSelection')">
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<input type="hidden" name="addressid" id="addressid" value="$adrressId"/>
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<input type="hidden" name="addressid" id="addressid" value="$adrressId"/>
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<input type="hidden" name="payment_option" id='payment_option' value="3000"/>
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<input type="hidden" name="payment_option" id='payment_option' value="3000"/>
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<div style="margin-left:250px; margin-top:10px ; margin-bottom:20px">
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<div style="margin-left:250px; margin-top:10px ; margin-bottom:20px">
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<img src="/captcha" id="captchaImage" /><br/><br/>
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<img src="/captcha" id="captchaImage" style="cursor: pointer;" /><br/><br/>
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<input type="text" name="captcha_response_field" autocomplete="off">
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<input type="text" name="captcha_response_field" autocomplete="off">
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<br/><small>Can't read the image? Click it to get a new one.</small>
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<br/><small>Can't read the image? Click it to get a new one.</small>
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</div>
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</div>
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<div class="text-center">
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<div class="text-center">
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<input type="submit" value="CONFIRM ORDER" class="make-payment-button"/>
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<input type="submit" value="CONFIRM ORDER" class="make-payment-button"/>
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