[%- USE T8 %]
[%- USE L %]
<h1>[% 'DATEX - Export Assistent' | $T8 %]</h1>

<form method='post' action='[% script %]' id='form'>

<table width=100%>
  <tr>
    <th align=left>[% 'DATEV Angaben' | $T8 %]</th>
  </tr>
  <tr height="5"></tr>
  <tr valign=top>
    <td>
      <table>
        <tr>
          <td align=left nowrap>[% 'Beraternummer' | $T8 %]</td>
          <td><input name=beraternr size=10 maxlength=7 value="[% beraternr %]"></td>

          <td align=left nowrap>[% 'DFV-Kennzeichen' | $T8 %]</td>
          <td><input name=dfvkz size=5 maxlength=2 value="[% dfvkz %]"></td>
        </tr>
        <tr>
          <td align=left nowrap>[% 'Beratername' | $T8 %]</td>
          <td><input name=beratername size=10 maxlength=9 value="[% beratername %]"></td>

          <td align=left nowrap>[% 'Password' | $T8 %]</td>
          <td><input name=passwort size=5 maxlength=4 value="[% passwort %]"></td>
        </tr>
        <tr>
          <td align=left nowrap>[% 'Mandantennummer' | $T8 %]</td>
          <td><input name=mandantennr size=10 maxlength=5 value="[% mandantennr %]"></td>

          <td align=left nowrap>[% 'Medium Number' | $T8 %]</td>
          <td><input name=datentraegernr size=5 maxlength=3 value="[% datentraegernr %]"></td>
        </tr>
        <tr>
          <td></td>
          <td></td>

          <td align=left nowrap>[% 'Abrechnungsnummer' | $T8 %]</td>
          <td><input name=abrechnungsnr size=5 maxlength=3 value="[% abrechnungsnr %]"></td>
        </tr>
      </table>
    </td>
  </tr>
</table>
[%- L.hidden_tag("exporttype",  0) %]
[%- L.hidden_tag("exportformat",  'csv') %]
</form>