<div class="page hidden" id="autofill-edit-credit-card-overlay">
<h1 id="autofill-credit-card-title"></h1>
<div class="content-area">
<div class="input">
<label>
<span i18n-content="nameOnCardLabel"></span><br>
<input type="text" id="name-on-card">
</label>
</div>
<div class="input">
<label>
<span i18n-content="creditCardNumberLabel"></span><br>
<input type="text" id="credit-card-number">
</label>
</div>
<div class="input">
<label>
<span i18n-content="creditCardExpirationDateLabel"></span><br>
<select id="expiration-month"></select>
<select id="expiration-year"></select>
</label>
</div>
</div>
<div class="action-area button-strip">
<button type="reset" id="autofill-edit-credit-card-cancel-button"
i18n-content="cancel"></button>
<button type="submit" id="autofill-edit-credit-card-apply-button" disabled
i18n-content="ok"></button>
</div>
</div>