<h1>Payment Method Details:</h1>
<hr />
<br />
<table class="pmDetails">
<tr>
  <th>Payment Method Nickname:</th>
  <td>{NICKNAME}</td>
</tr>
<tr>
  <th>Card Number:</th>
  <td>{CARD_NUMBER}</td>
</tr>
<tr>
  <th>Method Type:</th>
  <td><select name="data[method_type]">{METHOD_TYPE}</select></td>
</tr>
<tr>
  <th>Card Type:</th>
  <td>{CARD_TYPE}</td>
</tr>
<tr>
  <th>Expiration Date:</th>
  <td><select>{EXP_MONTH}</select>/<select>{EXP_YEAR}</select></td>
</tr>
<tr>
  <th>Type:</th>
  <td>{TYPE}</td>
</tr>
<tr>
  <th>Cardholder's Name:</th>
  <td>{CARDHOLDER_NAME}</td>
</tr>
<tr>
  <th>Address Line 1:</th>
  <td>{ADDRESS1}</td>
</tr>
<tr>
  <th>Address Line 2:</th>
  <td>{ADDRESS2}</td>
</tr>
<tr>
  <th>City:</th>
  <td>{CITY}</td>
</tr>
<tr>
  <th>State:</th>
  <td>{STATE}</td>
</tr>
<tr>
  <th>Zip:</th>
  <td>{ZIP}</td>
</tr>
</table>