diff options
Diffstat (limited to 'fs_selfservice/FS-SelfService/cgi/signup.html')
| -rwxr-xr-x | fs_selfservice/FS-SelfService/cgi/signup.html | 4 |
1 files changed, 2 insertions, 2 deletions
diff --git a/fs_selfservice/FS-SelfService/cgi/signup.html b/fs_selfservice/FS-SelfService/cgi/signup.html index 447f39af0..16ef7f726 100755 --- a/fs_selfservice/FS-SelfService/cgi/signup.html +++ b/fs_selfservice/FS-SelfService/cgi/signup.html @@ -216,8 +216,8 @@ else { my %paybychecked = ( 'CARD' => '<TABLE BGCOLOR="'. ( $box_bgcolor || '#c0c0c0' ). qq!" BORDER=0 CELLSPACING=0 WIDTH="100%"><TR><TD ALIGN="right"><font color="#ff0000">*</font> Card type</TD><TD>$cardselect</TD></TR><TR><TD ALIGN="right"><font color="#ff0000">*</font> Card number</TD><TD><INPUT TYPE="text" NAME="CARD_payinfo" VALUE="$payinfo" MAXLENGTH=19></TD></TR><TR><TD ALIGN="right"><font color="#ff0000">*</font> Expiration</TD><TD>!. expselect("CARD", $paydate). qq!</TD></TR><TR><TD ALIGN="right"><font color="#ff0000">*</font> Name on card</TD><TD><INPUT TYPE="text" NAME="CARD_payname" VALUE="$payname"></TD></TR>!, 'DCRD' => qq!Credit card<BR><font color="#ff0000">*</font>$cardselect<INPUT TYPE="text" NAME="DCRD_payinfo" VALUE="$payinfo" MAXLENGTH=19><BR><font color="#ff0000">*</font>Exp !. expselect("DCRD", $paydate). qq!<BR><font color="#ff0000">*</font>Name on card<BR><INPUT TYPE="text" NAME="DCRD_payname" VALUE="$payname">!, - 'CHEK' => qq!Electronic check<BR>${r}Account number <INPUT TYPE="text" NAME="CHEK_payinfo1" VALUE="$account" MAXLENGTH=10> Type <SELECT NAME="CHEK_paytype">!. join('', map {qq!<OPTION VALUE="$_"!.($paytype eq $_ ? 'SELECTED' : '').">$_</OPTION>"} @paytypes). qq!</SELECT><BR>${r}ABA/Routing code <INPUT TYPE="text" NAME="CHEK_payinfo2" VALUE="$aba" SIZE=10 MAXLENGTH=9><INPUT TYPE="hidden" NAME="CHEK_month" VALUE="12"><INPUT TYPE="hidden" NAME="CHEK_year" VALUE="2037"><BR>${r}Bank name <INPUT TYPE="text" NAME="CHEK_payname" VALUE="$payname">!, - 'DCHK' => qq!Electronic check<BR>${r}Account number <INPUT TYPE="text" NAME="DCHK_payinfo1" VALUE="$account" MAXLENGTH=10> Type <SELECT NAME="DCHK_paytype">!. join('', map {qq!<OPTION VALUE="$_"!.($paytype eq $_ ? 'SELECTED' : '').">$_</OPTION>"} @paytypes). qq!</SELECT><BR>${r}ABA/Routing code <INPUT TYPE="text" NAME="DCHK_payinfo2" VALUE="$aba" SIZE=10 MAXLENGTH=9><INPUT TYPE="hidden" NAME="DCHK_month" VALUE="12"><INPUT TYPE="hidden" NAME="DCHK_year" VALUE="2037"><BR>${r}Bank name <INPUT TYPE="text" NAME="DCHK_payname" VALUE="">!, + 'CHEK' => qq!Electronic check<BR>${r}Account number <INPUT TYPE="text" NAME="CHEK_payinfo1" VALUE="$account" MAXLENGTH=10> Type <SELECT NAME="CHEK_paytype">!. join('', map {qq!<OPTION VALUE="$_"!.($paytype eq $_ ? ' SELECTED' : '').">$_</OPTION>"} @paytypes). qq!</SELECT><BR>${r}ABA/Routing code <INPUT TYPE="text" NAME="CHEK_payinfo2" VALUE="$aba" SIZE=10 MAXLENGTH=9><INPUT TYPE="hidden" NAME="CHEK_month" VALUE="12"><INPUT TYPE="hidden" NAME="CHEK_year" VALUE="2037"><BR>${r}Bank name <INPUT TYPE="text" NAME="CHEK_payname" VALUE="$payname">!, + 'DCHK' => qq!Electronic check<BR>${r}Account number <INPUT TYPE="text" NAME="DCHK_payinfo1" VALUE="$account" MAXLENGTH=10> Type <SELECT NAME="DCHK_paytype">!. join('', map {qq!<OPTION VALUE="$_"!.($paytype eq $_ ? ' SELECTED' : '').">$_</OPTION>"} @paytypes). qq!</SELECT><BR>${r}ABA/Routing code <INPUT TYPE="text" NAME="DCHK_payinfo2" VALUE="$aba" SIZE=10 MAXLENGTH=9><INPUT TYPE="hidden" NAME="DCHK_month" VALUE="12"><INPUT TYPE="hidden" NAME="DCHK_year" VALUE="2037"><BR>${r}Bank name <INPUT TYPE="text" NAME="DCHK_payname" VALUE="">!, 'LECB' => qq!Phone bill billing<BR>${r}Phone number <INPUT TYPE="text" BANE="LECB_payinfo" VALUE="$payinfo" MAXLENGTH=15 SIZE=16><INPUT TYPE="hidden" NAME="LECB_month" VALUE="12"><INPUT TYPE="hidden" NAME="LECB_year" VALUE="2037"><INPUT TYPE="hidden" NAME="LECB_payname" VALUE="">!, 'BILL' => qq!Billing<BR>P.O. <INPUT TYPE="text" NAME="BILL_payinfo" VALUE="$payinfo"><BR><INPUT TYPE="hidden" NAME="BILL_month" VALUE="12"><INPUT TYPE="hidden" NAME="BILL_year" VALUE="2037">Attention<INPUT TYPE="text" NAME="BILL_payname" VALUE="$payname">!, 'COMP' => qq!Complimentary<BR><font color="#ff0000">*</font>Approved by<INPUT TYPE="text" NAME="COMP_payinfo" VALUE="$payinfo"><BR><font color="#ff0000">*</font>Exp !. expselect("COMP", $paydate), |