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gaia/apps/costcontrol/elements/topup-dialog.html

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+<element name="topup-dialog" extends="section">
+  <template>
+
+    <gaia-header id="topup-header" action="close">
+      <h1 data-l10n-id="top-up"></h1>
+      <button id="topup-send-button" data-l10n-id="send">Send</button>
+    </gaia-header>
+    <section class="content">
+      <div class="info">
+        <h2 data-l10n-id="enter-top-up-code">
+          Enter the top up code
+        </h2>
+        <p id="topup-code-explanation" data-l10n-id="top-up-code-explanation2">
+          Find it on the scratch card or directly in your receipt.
+        </p>
+        <p id="topup-incorrect-code" hidden data-l10n-id="incorrect-code2">
+          Make sure the code is correct and try again.
+        </p>
+        <p id="topup-error" hidden data-l10n-id="topup-error2">
+          There was a problem sending the code. Please, try again.
+        </p>
+        <section hidden class="loading" id="topup-in-progress">
+          <progress>
+          </progress>
+          <p data-l10n-id="wait-for-confirmation">
+            You'll receive a confirmation message
+          </p>
+        </section>
+      </div>
+    </section>
+    <form>
+      <input id="topup-code-input" type="number" />
+    </form>
+
+  </template>
+</element>