<%FORMNAME%>
<%SELECTMODE%> <%UPGRADEFORM%>
{@Full name@}:
{@E-mail@}:
{@Password@}:
{@Confirm Password@}:
{@Country@}:
{@TimeZone@}:
{@City@}:
{@State@}:
{@Address@}:
{@ZIP/Postal Code@}:
{@Phone #@}:
<%COUPONS_SETTINGS%>
{@Our system applicants must agree the following Terms and Conditions@}
<%TERMS%>
{@I certify that I have read and agree with the these Terms and Conditions@}
<%NEEDAGREE%>
<%BUTTONNAME%>
{@Cancel@}
- {@required fields@}.