1 <div class="page hidden" id="autofill-edit-credit-card-overlay"> 2 <h1 id="autofill-credit-card-title"></h1> 3 <div class="content-area"> 4 <div class="input"> 5 <label> 6 <span i18n-content="nameOnCardLabel"></span><br> 7 <input type="text" id="name-on-card"> 8 </label> 9 </div> 10 <div class="input"> 11 <label> 12 <span i18n-content="creditCardNumberLabel"></span><br> 13 <input type="text" id="credit-card-number"> 14 </label> 15 </div> 16 <div class="input"> 17 <label> 18 <span i18n-content="creditCardExpirationDateLabel"></span><br> 19 <select id="expiration-month"></select> 20 <select id="expiration-year"></select> 21 </label> 22 </div> 23 </div> 24 <div class="action-area button-strip"> 25 <button type="reset" id="autofill-edit-credit-card-cancel-button" 26 i18n-content="cancel"></button> 27 <button type="submit" id="autofill-edit-credit-card-apply-button" disabled 28 i18n-content="ok"></button> 29 </div> 30 </div> 31