<!-- IF CAPTCHA_HTML -->
<script type="text/javascript">
ajax.callback.user_register = function(data){
	$('#'+ data.mode).html(data.html);
};
</script>
<!-- ENDIF -->
<div class="col-md-12">
<div class="panel">
    <div class="panel-heading">
        <div class="panel-title">{L_FORGOTTEN_PASSWORD}</div>
    </div>
    <div class="panel-body">
		<form class="form-horizontal" action="{S_PROFILE_ACTION}" method="post">
		{S_HIDDEN_FIELDS}
	
			<div class="form-group">
				<p class="col-md-12 m-b-1 text-center">{L_ITEMS_REQUIRED}</p>
				<label class="col-md-3 control-label">{L_EMAIL_ADDRESS}: *</label>
				<div class="col-md-9">
					<input type="text" class="form-control" name="email" size="50" maxlength="255">
				</div>
			</div>
			
			<!-- IF CAPTCHA_HTML -->
			<hr class="page-wide-block">
			<div class="form-group">
				<label class="col-md-3 control-label">{L_CAPTCHA}: *</label>
				<div class="col-md-9">
					{CAPTCHA_HTML}
				</div>
			</div>
			<!-- ENDIF -->
			<hr class="page-wide-block">
			<div class="form-group m-a-0 text-center">
				<input type="submit" name="submit" class="btn" value="{L_SUBMIT}" />
				<input type="reset" name="reset" class="btn" value="{L_RESET}" />
			</div>
		</form>
	</div>
</div>
</div>