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+<form id="reserve-form" name="tform" action="never_used" onsubmit="return MERCHtrigSubmission()" method="POST">
+ Which mint? Indicate mint's URL below :<br><input id="mint-url" type="text" name="pbk" value="demo.taler.net"></input><br>
+ Your Public Key Here :<br><input type="text" name="pbk"></input><br>
+ Amount :<br>
+ <select id="taler-amount" name="kudos-amount">
+ <option value="1000">1000</option>
+ <option value="1">1</option>
+ <option value="5">5</option>
+ <option value="10">10</option>
+ </select><br><br>
+ Currency :<br>
+ <select id="taler-amount-currency" name="kudos-currency">
+ <option value="EUR">Euro</option>
+ <option value="JPY">Yen</option>
+ <option value="LRD">Liberian Dollar</option>
+ </select><br><br>
+
+<input type="submit" value="Submit"></input><br>
+</form>