| <HTML> | |
| <BODY> | |
| <form> | |
| <TABLE border="1"> | |
| <TR> | |
| <TD> | |
| <TABLE border="2"> | |
| <TR> | |
| <TD WIDTH="30%"> | |
| Member Number: | |
| </TD> | |
| <TD WIDTH="70%"> | |
| <INPUT NAME="EchoUser" TYPE="TEXT"> | |
| </TD> | |
| </TR> | |
| <TR> | |
| <TD> | |
| PIN: | |
| </TD> | |
| <TD> | |
| <INPUT TYPE="password"> | |
| </TD> | |
| <TD> | |
| </TD> | |
| </TR> | |
| </TABLE> | |
| </TD> | |
| </TR> | |
| </TABLE> | |
| </Form> | |
| </BODY> | |
| </HTML> | |