".$msg['scan_request_user_only']."

".$msg['scan_request_form_date']."

".$msg['scan_request_form_wish_date']."

".$msg['scan_request_form_deadline_date']."

".(isset($pmb_scan_request_location_activate) && $pmb_scan_request_location_activate ? "

".$msg['scan_request_location_search']."

!!scan_request_location_selector!!

" : "") ."