<div class="Block Moveable Panel" id="AccountNewReturnInfo" style="display: %%GLOBAL_HideReturnForm%%">
	<div class="BlockContent">
		<div class="FormContainer HorizontalFormContainer">
			<dl>
				<dt><span class="Required">*</span> %%LNG_ReturnReason%%:</dt>
				<dd>
					<select name="return_reason" id="return_reason" class="form-control">
						<option value="">%%LNG_ChooseReturnReason%%</option>
						%%GLOBAL_ReturnReasonsList%%
					</select>
				</dd>
				<br>
				<dt style="display: %%GLOBAL_HideReturnAction%%">&nbsp;&nbsp; %%LNG_ReturnAction%%:</dt>
				<dd style="display: %%GLOBAL_HideReturnAction%%">
					<select name="return_action" id="return_action" class="form-control">
						<option value="">%%LNG_ChooseReturnAction%%</option>
						%%GLOBAL_ReturnActionsList%%
					</select>
				</dd>
				<br>
				<dt>&nbsp;&nbsp; %%LNG_ReturnComments%%:</dt>
				<dd>
					<textarea name="return_comments" id="return_comments" cols="60" rows="7" class="form-control"></textarea>
				</dd>
			</dl>
			<p class="Submit">
				<input type="submit" value="%%LNG_SubmitReturn%%" class="btn btn-primary"/>
			</p>
		</div>
	</div>
</div>