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 | 42 |
1 files changed, 42 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 0000000..09391e7 --- /dev/null +++ b/fs_selfservice/FS-SelfService/cgi/make_ach_payment.html @@ -0,0 +1,42 @@ +<%= $url = "$selfurl?session=$session_id;action="; ''; %> +<%= include('header', 'Make a payment') %> + +<FORM NAME="OneTrueForm" METHOD="POST" ACTION="<%=$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> +<%= include('check') %> +<TR> + <TD COLSPAN=2> + <INPUT TYPE="checkbox" <%= $save_unchecked ? '' : '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> + +<%= include('footer') %> |