$sc_verifytable_at_checkout = qq|
<div class="col-xs-12 col-sm-12 col-md-12 col-lg-12" align="center">
<br>
<p class="ac_checkout_top_msg">$my_message</p>

<div class="col-xs-12 col-sm-12 col-md-12 col-lg-12 ac_checkout_table">
<div class="col-xs-12 col-sm-12 col-md-12 col-lg-12 ac_checkout_review">Donor Information</div>

<div class="col-xs-12 col-sm-12 col-md-12 col-lg-12 ac_checkout_table_row">
<div class="col-xs-4 col-sm-4 col-md-3 col-lg-3 ac_checkout_review_col1">Company</div>
<div class="col-xs-8 col-sm-8 col-md-9 col-lg-9 ac_checkout_review_col2">$form_data{'Ecom_ShipTo_Company_Name'}</div>
</div>

<div class="col-xs-12 col-sm-12 col-md-12 col-lg-12 ac_checkout_table_row">
<div class="col-xs-4 col-sm-4 col-md-3 col-lg-3 ac_checkout_review_col1">Name</div>
<div class="col-xs-8 col-sm-8 col-md-9 col-lg-9 ac_checkout_review_col2">
  $form_data{'Ecom_ShipTo_Postal_Name_First'} $form_data{'Ecom_ShipTo_Postal_Name_Last'}
</div>
</div>

<div class="col-xs-12 col-sm-12 col-md-12 col-lg-12 ac_checkout_table_row">
<div class="col-xs-4 col-sm-4 col-md-3 col-lg-3 ac_checkout_review_col1">E-Mail</div>
<div class="col-xs-8 col-sm-8 col-md-9 col-lg-9 ac_checkout_review_col2">$form_data{'Ecom_BillTo_Online_Email'}</div>
</div>

<div class="col-xs-12 col-sm-12 col-md-12 col-lg-12 ac_checkout_table_row">
<div class="col-xs-4 col-sm-4 col-md-3 col-lg-3 ac_checkout_review_col1">City</div>
<div class="col-xs-8 col-sm-8 col-md-9 col-lg-9 ac_checkout_review_col2">$form_data{'Ecom_ShipTo_Postal_City'}</div>
</div>

<div class="col-xs-12 col-sm-12 col-md-12 col-lg-12 ac_checkout_table_row">
<div class="col-xs-4 col-sm-4 col-md-3 col-lg-3 ac_checkout_review_col1">State</div>
<div class="col-xs-8 col-sm-8 col-md-9 col-lg-9 ac_checkout_review_col2">$form_data{'Ecom_ShipTo_Postal_StateProv'}</div>
</div>

<div class="col-xs-12 col-sm-12 col-md-12 col-lg-12 ac_checkout_table_row">
<div class="col-xs-4 col-sm-4 col-md-3 col-lg-3 ac_checkout_review_col1">Zip</div>
<div class="col-xs-8 col-sm-8 col-md-9 col-lg-9 ac_checkout_review_col2">$form_data{'Ecom_ShipTo_Postal_PostalCode'}</div>
</div>

<div class="col-xs-12 col-sm-12 col-md-12 col-lg-12 ac_checkout_table_row">
<div class="col-xs-4 col-sm-4 col-md-3 col-lg-3 ac_checkout_review_col1">Country</div>
<div class="col-xs-8 col-sm-8 col-md-9 col-lg-9 ac_checkout_review_col2">$form_data{'Ecom_ShipTo_Postal_CountryCode'}</div>
</div>

</div></div>
<div class="col-xs-12 col-sm-12 col-md-12 col-lg-12"><p><br><br></p></div>

<div class="ac_checkout_review_buttons">
<p><br><br></p>
<div class="col-xs-12 col-sm-12 col-md-7 col-lg-8 ac_checkout_review_buttonL">
    <input class="btn btn-primary btn-lg pull-right hidden-xs" role="button" type="submit" name="Submit" value="$agora_verify_page_submit_button_text$myname">
    <input class="btn btn-primary btn-sm btn-block visible-xs" role="button" type="submit" name="Submit" value="$agora_verify_page_submit_button_text$myname">
    <p class="visible-xs"></p>
</div>
</form>
<div class="col-xs-12 col-sm-12 col-md-5 col-lg-4 ac_checkout_review_buttonR">
<form method="post" action="$sc_stepone_order_script_url">
<input type="hidden" name="order_form_button" value="1">
$HREF_FIELDS
<input type="hidden" name="gateway" value="$myname">
<input type="hidden" name="ofn" value="$myname">
<input class="btn btn-default btn-lg pull-left hidden-xs" role="button" type="submit" name="Make Changes" value="$agora_make_changes_button_text">
<input class="btn btn-default btn-sm btn-block visible-xs" role="button" type="submit" name="Make Changes" value="$agora_make_changes_button_text">
</form>
</div>
</div>

<div class="col-xs-12 col-sm-12 col-md-12 col-lg-12 hidden-xs"><p><br><br><br></p></div>
|;
