diff options
| author | ivan <ivan> | 2003-05-18 08:09:41 +0000 |
|---|---|---|
| committer | ivan <ivan> | 2003-05-18 08:09:41 +0000 |
| commit | 2c88b03550a72438bbd75ec7461d2c26fc797efc (patch) | |
| tree | b8804c1761fd7cd92e9e748fad4d2f6723bbff47 /fs_selfservice/FS-SelfService/cgi/make_payment.html | |
| parent | 416dc3b6df09133c4130445008919408f04586c3 (diff) | |
forgot this file
Diffstat (limited to 'fs_selfservice/FS-SelfService/cgi/make_payment.html')
| -rw-r--r-- | fs_selfservice/FS-SelfService/cgi/make_payment.html | 118 |
1 files changed, 118 insertions, 0 deletions
diff --git a/fs_selfservice/FS-SelfService/cgi/make_payment.html b/fs_selfservice/FS-SelfService/cgi/make_payment.html new file mode 100644 index 0000000..d469bdd --- /dev/null +++ b/fs_selfservice/FS-SelfService/cgi/make_payment.html @@ -0,0 +1,118 @@ +<HTML><HEAD><TITLE>MyAccount</TITLE></HEAD> +<BODY BGCOLOR="#eeeeee"><FONT SIZE=5>MyAccount</FONT><BR><BR> +<%= $url = "$selfurl?session=$session_id;action="; ''; %> +<TABLE BORDER=0 CELLPADDING=4><TR><TD VALIGN="top" HEIGHT=384 BGCOLOR="#dddddd"> +<A HREF="<%= $url %>myaccount">MyAccount</A><BR> +<!-- <A HREF="<%= $url %>other">SomethingElse</A><BR> --> +</TD><TD VALIGN="top"> +<FONT SIZE=4>Make a payment</FONT><BR><BR> +<FORM METHOD="POST" ACTION="<%=$selfurl%>"> +<INPUT TYPE="hidden" NAME="session" VALUE="<%=$session_id%>"> +<INPUT TYPE="hidden" NAME="action" VALUE="process_payment"> +<TABLE BGCOLOR="#cccccc"> +<TR> + <TD ALIGN="right">Amount Due</TD> + <TD> + <TABLE><TR><TD BGCOLOR="#ffffff"> + $<%=sprintf("%.2f",$balance)%> + </TD></TR></TABLE> + </TD> +</TR> +<TR> + <TD ALIGN="right">Payment amount</TD> + <TD> + <TABLE><TR><TD BGCOLOR="#ffffff"> + $<INPUT TYPE="text" NAME="amount" SIZE=8 VALUE="<%=sprintf("%.2f",$balance)%>"> + </TD></TR></TABLE> + </TD> +</TR><TR> + <TD ALIGN="right">Card type</TD> + <TD> + <SELECT NAME="card_type"><OPTION></OPTION> + <%= foreach ( keys %$card_types ) { + $selected = $card_type eq $card_types->{$_} ? ' SELECTED' : ''; + $OUT .= qq(<OPTION$selected VALUE="). $card_types->{$_}. qq(">$_\n); + } %> + </SELECT> + </TD> +</TD><TR> + <TD ALIGN="right">Card number</TD> + <TD> + <TABLE> + <TR> + <TD> + <INPUT TYPE="text" NAME="payinfo" SIZE=20 MAXLENGTH=19 VALUE="<%=$payinfo%>"> </TD> + <TD>Exp.</TD> + <TD> + <SELECT NAME="month"> + <%= for ( ( map "0$_", 1 .. 9 ), 11, 12 ) { + $OUT .= '<OPTION'. ($_ eq $month ? ' SELECTED' : ''). ">$_\n"; + } %> + </SELECT> + </TD> + <TD> / </TD> + <TD> + <SELECT NAME="year"> + <%= for ( 2003 .. 2012 ) { + $OUT .= '<OPTION'. ($_ eq $year ? ' SELECTED' : ''). ">$_\n"; + } %> + </SELECT> + </TD> + </TR> + </TABLE> + </TD> +</TR><TR> + <TD ALIGN="right">Exact name on card</TD> + <TD><INPUT TYPE="text" SIZE=32 MAXLENGTH=80 NAME="payname" SVALUE="<%=$payname%>"></TD> +</TR><TR> + <TD ALIGN="right">Card billing address</TD> + <TD> + <INPUT TYPE="text" SIZE=40 MAXLENGTH=80 NAME="address1" VALUE="<%=$address1%>"> + </TD> +</TR><TR> + <TD ALIGN="right">Address line 2</TD> + <TD> + <INPUT TYPE="text" SIZE=40 MAXLENGTH=80 NAME="address2" VALUE="<%=$address2%>"> + </TD> +</TR><TR> + <TD ALIGN="right">City</TD> + <TD> + <TABLE> + <TR> + <TD> + <INPUT TYPE="text" NAME="city" SIZE="12" MAXLENGTH=80 VALUE="<%=$city%>"> + </TD> + <TD>State</TD> + <TD> + <SELECT NAME="state"> + <%= for ( @$states ) { + $OUT .= '<OPTION'. ($_ eq $state ? ' SELECTED' : '' ). ">$_\n"; + } %> + </SELECT> + </TD> + <TD>Zip</TD> + <TD> + <INPUT TYPE="text" NAME="zip" SIZE=11 MAXLENGTH=10 VALUE="<%=$zip%>"> + </TD> + </TR> + </TABLE> + </TD> +</TR><TR> + <TD COLSPAN=2> + <INPUT TYPE="checkbox" CHECKED NAME="save"> + Remember this information + </TD> +</TR><TR> + <TD COLSPAN=2> + <INPUT TYPE="checkbox"<%= $payby eq 'CARD' ? ' CHECKED' : '' %> NAME="CARD"> + Charge future payments to this card automatically + </TD> +</TR> +</TABLE> +<INPUT TYPE="submit" VALUE="Process payment"> +</FORM> +</TD></TR></TABLE> +<HR> +<FONT SIZE="-2">powered by <a href="http://www.sisd.com/freeside">freeside</a></FONT> +</BODY></HTML> + |