[% FOR xact IN CGI.param('xact') %] [% END %] [% FOR xact IN CGI.param('xact_misc') %] [% END %] [% IF ctx.use_stripe %] [% END %] [% USE zip=String(ctx.user.billing_address.post_code) %]

[% l('Billing Information') %]
[% l('First Name') %]
[% l('Last Name') %]
[% l('Email Address') %]	[% l("Update") %]
[% l('Street Address') %]
[% l('City' )%]
[% l('State or Province') %]
[% l('Postal Code') %]

[% l('Credit Card Information') %]
[% l('Credit Card #') %]
[% l('Security Code') %]
[% l('Expiration Month') %]
[% l('Expiration Year') %]
[% l('Total amount:') %] [% money(ctx.fines.balance_owed) %] [% l('Cancel') %]

[% INCLUDE "opac/parts/myopac/main_refund_policy.tt2" %]