<fieldset>
    <legend>{NOTE_LEGEND}</legend>
    <table class="formFields" cellspacing="0" width="100%">
        <tr>
            <td class="name"><label for="fid-{SUBJECT}">{SUBJECT_TEXT}</label>&nbsp;{REQ}</td>
            <td><input type="text" name="{SUBJECT}" id="fid-{SUBJECT}" value="{SUBJECT_VALUE}" class="f-max-size input-text"></td>
        </tr>
    </table>
    <table class="formFields" cellspacing="0" width="100%">
        <tr>
            <td class="name"><label for="fid-{NOTE}">{NOTE_TEXT}</label>&nbsp;{REQ}</td>
            <td><textarea rows="15" cols="50" name="{NOTE}" id="fid-{NOTE}" class="f-max-size">{NOTE_VALUE}</textarea></td>
        </tr>
    </table>
</fieldset>

<input type="hidden" name="code" value="{NOTIFICATION_CODE}">
