diff options
Diffstat (limited to 'fs_selfservice/FS-SelfService/cgi/make_ach_payment.html')
| -rw-r--r-- | fs_selfservice/FS-SelfService/cgi/make_ach_payment.html | 111 |
1 files changed, 111 insertions, 0 deletions
diff --git a/fs_selfservice/FS-SelfService/cgi/make_ach_payment.html b/fs_selfservice/FS-SelfService/cgi/make_ach_payment.html new file mode 100644 index 000000000..83d36b9b9 --- /dev/null +++ b/fs_selfservice/FS-SelfService/cgi/make_ach_payment.html @@ -0,0 +1,111 @@ +<HTML><HEAD><TITLE>MyAccount</TITLE></HEAD> +<BODY BGCOLOR="#eeeeee"> +<script language="JavaScript"><!-- + var mywindow = -1; + function myopen(filename,windowname,properties) { + myclose(); + mywindow = window.open(filename,windowname,properties); + } + function myclose() { + if ( mywindow != -1 ) + mywindow.close(); + mywindow = -1 + } +//--></script> +<FONT SIZE=5>MyAccount</FONT><BR><BR> +<%= $url = "$selfurl?session=$session_id;action="; ''; %> +<%= include('myaccount_menu') %> +<TD VALIGN="top"> +<FONT SIZE=4>Make a payment</FONT><BR><BR> +<FORM NAME="OneTrueForm" METHOD="POST" ACTION="<%=$selfurl%>" onSubmit="document.OneTrueForm.process.disabled=true"> +<INPUT TYPE="hidden" NAME="session" VALUE="<%=$session_id%>"> +<INPUT TYPE="hidden" NAME="action" VALUE="ach_payment_results"> +<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">Account type</TD> + <TD> + <SELECT NAME="paytype"><OPTION></OPTION> + <%= foreach ( @paytypes ) { + $selected = $paytype eq $_ ? ' SELECTED' : ''; + $OUT .= qq(<OPTION$selected VALUE="$_">$_\n); + } %> + </SELECT> + </TD> +</TD><TR> + <TD ALIGN="right">Account number</TD> + <TD><INPUT TYPE="text" NAME="payinfo1" SIZE=10 MAXLENGTH=20 VALUE="<%=$payinfo1%>"></TD> +</TD><TR> + <TD ALIGN="right">ABA/Routing number</TD> + <TD><INPUT TYPE="text" NAME="payinfo2" SIZE=10 MAXLENGTH=9 VALUE="<%=$payinfo2%>"></TD> +</TR><TR> + <TD ALIGN="right">Bank name</TD> + <TD><INPUT TYPE="text" SIZE=32 MAXLENGTH=80 NAME="payname" VALUE="<%=$payname%>"></TD> +</TR><TR> + <%= + $OUT = ''; + if ($show_paystate) { + $OUT .= qq!<TD ALIGN="right">Bank state</TD><TD><SELECT NAME="paystate">!; + for ( @states ) { + $OUT .= '<OPTION'. ($_ eq $paystate ? ' SELECTED' : '' ). ">$_\n"; + } + $OUT .= '</SELECT></TD></TR><TR>'; + } + %> + <%= + $OUT = ''; + if ($show_ss) { + $OUT .= '<TD ALIGN="right">Account holder<BR>Social '; + $OUT .= 'security or tax ID #</TD><TD>'; + $OUT .= qq!<INPUT TYPE="text" SIZE=32 MAXLENGTH=80 NAME="ss" VALUE="$ss">!; + $OUT .= '</TD></TR><TR>'; + } + %> + <%= + $OUT = ''; + if ($show_stateid) { + $OUT .= '<TD ALIGN="right">'; + $OUT .= qq!Account holder<BR>$stateid_label</TD><TD>!; + $OUT .= qq!<INPUT TYPE="text" SIZE=32 MAXLENGTH=80 NAME="stateid" VALUE="$stateid"></TD>!; + $OUT .= qq!<TD ALIGN="right">$stateid_state_label</TD>!; + $OUT .= '<TD><SELECT NAME="stateid_state">'; + for ( @states ) { + $OUT .= '<OPTION'. ($_ eq $stateid_state ? ' SELECTED' : '' ). ">$_\n"; + } + $OUT .='</SELECT></TD></TR><TR>'; + } + %> + <TD COLSPAN=2> + <INPUT TYPE="checkbox" CHECKED NAME="save" VALUE="1"> + Remember this information + </TD> +</TR><TR> + <TD COLSPAN=2> + <INPUT TYPE="checkbox"<%= $payby eq 'CHEK' ? ' CHECKED' : '' %> NAME="auto" VALUE="1" onClick="if (this.checked) { document.OneTrueForm.save.checked=true; }"> + Charge future payments to this account automatically + </TD> +</TR> +</TABLE> +<BR> +<INPUT TYPE="hidden" NAME="paybatch" VALUE="<%=$paybatch%>"> +<INPUT TYPE="submit" NAME="process" VALUE="Process payment"> <!-- onClick="this.disabled=true"> --> +</FORM> +</TD></TR></TABLE> +<HR> +<FONT SIZE="-2">powered by <a href="http://www.sisd.com/freeside">freeside</a></FONT> +</BODY></HTML> + |