<script>
function verifyForm(){
	alert("hi ! "+document.getElementById("Username").value+", "+document.getElementById("Password").value);
}
</script>
                <tr>
                	<td>
                    	<table cellpadding="0" cellspacing="0" border="0" align="center" class="container">
                            <tr>
                            	<td class="content-header">
                    				<div><img src="images/blue-arrow.png"/><font> <?php echo $word[$lang]['054']; ?></font></div>
                                </td>
                            </tr>
                            <tr>
                                <td class="content">
                    				<table cellpadding="0" cellspacing="0" border="0">
                                        <tr><td style="height:30px;"></td></tr>
                                    	<tr>
                                        	<td style="width:77px;">
                                            </td>
                                            <td class="content-field">
                                            	<?php echo $word[$lang]['055']; ?>
                                            </td>
                                        	<td style="width:77px;">
                                            </td>
                                        </tr>
                                    </table>
                                </td>
                            </tr>
                        </table>
                    </td>
                </tr>