<div class="form-block">
	<div class="block-header"><?php echo $this->lng_m['mod_name']; ?></div>
	<div class="block-line"></div>

	<div class="mcr-restore">
		<form class="form-horizontal" method="post">

			<div class="control-group">
				<label class="control-label" for="inputEmail"><?php echo $this->lng['email']; ?></label>
				<div class="controls">
					<input type="text" name="email" class="span7" id="inputEmail" placeholder="<?php echo $this->lng['email']; ?>" required>
				</div>
			</div>

			<div class="control-group">
				<div class="controls">
					<button type="submit" name="submit" class="btn"><?php echo $this->lng_m['btn_restore']; ?></button>
				</div>
			</div>
		</form>
	</div>
</div>