<br>
<form action="" method=POST>

<table width=519>
	<tr>
	  <td class=c colspan=2>{your_apply}</td>
	</tr>
	<tr>
	  <th colspan=2>{request_text}</th>
	</tr>
	<tr>
	  <th colspan=2><input type=submit name="bcancel" value="{button_text}"></th>
	</tr>
</table>
</form>