<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="payment_id" value="[% HTML.escape(payment_id) %]">
<input type="hidden" name="printed" value="[% HTML.escape(printed) %]">
<input type="hidden" name="proforma" value="[% HTML.escape(proforma) %]">
<input type="hidden" name="queued" value="[% HTML.escape(queued) %]">
<input type="hidden" name="shiptocontact" value="[% HTML.escape(shiptocontact) %]">
<input type="hidden" name="shiptocp_gender" value="[% HTML.escape(shiptocp_gender) %]">
<input type="hidden" name="shiptocountry" value="[% HTML.escape(shiptocountry) %]">
+ <input type="hidden" name="shiptogln" value="[% HTML.escape(shiptogln) %]">
<input type="hidden" name="shiptodepartment_1" value="[% HTML.escape(shiptodepartment_1) %]">
<input type="hidden" name="shiptodepartment_2" value="[% HTML.escape(shiptodepartment_2) %]">
<input type="hidden" name="shiptoemail" value="[% HTML.escape(shiptoemail) %]">