<input type="hidden" name="max_dunning_level" value="[% HTML.escape(max_dunning_level) %]">
<input type="hidden" name="media" value="[% HTML.escape(media) %]">
<input type="hidden" name="message" value="[% HTML.escape(message) %]">
<input type="hidden" name="max_dunning_level" value="[% HTML.escape(max_dunning_level) %]">
<input type="hidden" name="media" value="[% HTML.escape(media) %]">
<input type="hidden" name="message" value="[% HTML.escape(message) %]">