<HTML>
<BODY>
<form>
<TABLE border="1">
<TR>
<TD>
<TABLE border="2">
<TR>
<TD WIDTH="30%">
Member Number:
</TD>
<TD WIDTH="70%">
<INPUT NAME="EchoUser" TYPE="TEXT">
</TD>
</TR>
<TR>
<TD>
PIN:
</TD>
<TD>
<INPUT TYPE="password">
</TD>
<TD>
</TD>
</TR>
</TABLE>
</TD>
</TR>
</TABLE>
</Form>
</BODY>
</HTML>