{$message} {include file="xtCore/pages/content.html"} {form type=form id=rescission_select_order_form name=rescission_select_order_form action='customer/rescission_confirmation' method=post conn=SSL} {form type=hidden name=page_action value=rescission_confirmation}

{txt key=TEXT_FIRSTNAME}*

{txt key=TEXT_LASTNAME}*

{txt key=text_email}*

{txt key=TEXT_ORDER_NUMBER}*

{txt key="TEXT_HEREBY_I_REVOKE_1"}

{txt key=TEXT_YOUR_CANCELATION_COMMENTS}

{if !$smarty.session.registered_customer} {if $smarty.const._STORE_CAPTCHA == 'ReCaptcha'}

{elseif $smarty.const._STORE_CAPTCHA == 'Standard'}

{txt key=TEXT_CAPTCHA}* {form id=captcha_code type=text name=captcha params='maxlength="30"'} {/if} {/if}

{$legal_text}

  {txt key=TEXT_CANCEL_ORDER_NOW}

{form type=formend}