1 <HTML><HEAD><TITLE>MyAccount</TITLE></HEAD>
2 <BODY BGCOLOR="#eeeeee">
3 <script language="JavaScript"><!--
5 function myopen(filename,windowname,properties) {
7 mywindow = window.open(filename,windowname,properties);
15 <FONT SIZE=5>MyAccount</FONT><BR><BR>
16 <%= $url = "$selfurl?session=$session_id;action="; ''; %>
17 <%= include('myaccount_menu') %>
19 <FONT SIZE=4>Make a payment</FONT><BR><BR>
20 <FORM NAME="OneTrueForm" METHOD="POST" ACTION="<%=$selfurl%>" onSubmit="document.OneTrueForm.process.disabled=true">
21 <INPUT TYPE="hidden" NAME="session" VALUE="<%=$session_id%>">
22 <INPUT TYPE="hidden" NAME="action" VALUE="payment_results">
23 <TABLE BGCOLOR="#cccccc">
25 <TD ALIGN="right">Amount Due</TD>
27 <TABLE><TR><TD BGCOLOR="#ffffff">
28 $<%=sprintf("%.2f",$balance)%>
33 <TD ALIGN="right">Payment amount</TD>
35 <TABLE><TR><TD BGCOLOR="#ffffff">
36 $<INPUT TYPE="text" NAME="amount" SIZE=8 VALUE="<%=sprintf("%.2f",$balance)%>">
40 <TD ALIGN="right">Card type</TD>
42 <SELECT NAME="card_type"><OPTION></OPTION>
43 <%= foreach ( keys %card_types ) {
44 $selected = $card_type eq $card_types{$_} ? ' SELECTED' : '';
45 $OUT .= qq(<OPTION$selected VALUE="). $card_types{$_}. qq(">$_\n);
50 <TD ALIGN="right">Card number</TD>
55 <INPUT TYPE="text" NAME="payinfo" SIZE=20 MAXLENGTH=19 VALUE="<%=$payinfo%>"> </TD>
59 <%= for ( ( map "0$_", 1 .. 9 ), 10 .. 12 ) {
60 $OUT .= '<OPTION'. ($_ == $month ? ' SELECTED' : ''). ">$_\n";
67 <%= my @a = localtime; for ( $a[5]+1900 .. $a[5]+1915 ) {
68 $OUT .= '<OPTION'. ($_ == $year ? ' SELECTED' : ''). ">$_\n";
76 <TD ALIGN="right">CVV2 (<A HREF="javascript:myopen('cvv2.html','cvv2','toolbar=no,location=no,directories=no,status=no,menubar=no,scrollbars=no,resizable=yes,copyhistory=no,width=480,height=288')">help</A>)</TD>
77 <TD><INPUT TYPE="text" NAME="paycvv" VALUE="" SIZE=4 MAXLENGTH=4></TD></TR>
79 <TD ALIGN="right">Exact name on card</TD>
80 <TD><INPUT TYPE="text" SIZE=32 MAXLENGTH=80 NAME="payname" VALUE="<%=$payname%>"></TD>
82 <TD ALIGN="right">Card billing address</TD>
84 <INPUT TYPE="text" SIZE=40 MAXLENGTH=80 NAME="address1" VALUE="<%=$address1%>">
87 <TD ALIGN="right">Address line 2</TD>
89 <INPUT TYPE="text" SIZE=40 MAXLENGTH=80 NAME="address2" VALUE="<%=$address2%>">
92 <TD ALIGN="right">City</TD>
97 <INPUT TYPE="text" NAME="city" SIZE="12" MAXLENGTH=80 VALUE="<%=$city%>">
101 <SELECT NAME="state">
102 <%= for ( @states ) {
103 $OUT .= '<OPTION'. ($_ eq $state ? ' SELECTED' : '' ). ">$_\n";
109 <INPUT TYPE="text" NAME="zip" SIZE=11 MAXLENGTH=10 VALUE="<%=$zip%>">
116 <INPUT TYPE="checkbox" CHECKED NAME="save" VALUE="1">
117 Remember this information
121 <INPUT TYPE="checkbox"<%= $payby eq 'CARD' ? ' CHECKED' : '' %> NAME="auto" VALUE="1" onClick="if (this.checked) { document.OneTrueForm.save.checked=true; }">
122 Charge future payments to this card automatically
127 <INPUT TYPE="hidden" NAME="paybatch" VALUE="<%=$paybatch%>">
128 <INPUT TYPE="submit" NAME="process" VALUE="Process payment"> <!-- onClick="this.disabled=true"> -->
132 <FONT SIZE="-2">powered by <a href="http://www.sisd.com/freeside">freeside</a></FONT>