<br />
<div id="content">
    <form action="" method="POST">
        <table width="519">
            <tr>
                <td class="c" colspan="2">{al_your_request_title}</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>
</div>