1 files changed, 88 insertions, 0 deletions
diff --git a/min_selfservice/elements/check.php b/min_selfservice/elements/check.php
new file mode 100644
index 000000000..fd0cd6d91
--- /dev/null
+++ b/min_selfservice/elements/check.php
@@ -0,0 +1,88 @@
+<? if ($ach_read_only) { $bgShade = 'BGCOLOR="#ffffff"';  } ?>
+<TR>
+  <TD ALIGN="right">Account&nbsp;type</TD>
+  <TD <? echo $bgShade; ?>>
+    <? if ($ach_read_only) { echo htmlspecialchars($paytype); ?>
+      <INPUT TYPE="hidden" NAME="paytype" VALUE="<? echo $paytype; ?>">
+    <? } else { ?>
+     <SELECT NAME="paytype">
+      <? foreach ( $paytypes AS $pt ) { ?>
+           <OPTION <? if ($pt == $paytype ) { echo 'SELECTED'; } ?> VALUE="<? echo $pt; ?>"><? echo $pt; ?>
+      <? } ?>
+     </SELECT>
+    <? } ?>
+  </TD>
+</TR><TR>
+  <TD ALIGN="right">Account&nbsp;number</TD>
+  <TD <? echo $bgShade; ?>>
+    <? if ($ach_read_only) { echo htmlspecialchars($payinfo1); ?>
+      <INPUT TYPE="hidden" NAME="payinfo1" VALUE="<? echo $payinfo1; ?>">
+    <? } else { ?>
+      <INPUT TYPE="text" NAME="payinfo1" SIZE=10 MAXLENGTH=20 VALUE="<? echo $payinfo1; ?>">
+    <? } ?>
+  </TD>
+</TR><TR>
+  <TD ALIGN="right">ABA/Routing&nbsp;number</TD>
+  <TD <? echo $bgShade; ?>>
+    <? if ($ach_read_only) { echo htmlspecialchars($payinfo2); ?>
+      <INPUT TYPE="hidden" NAME="payinfo2" VALUE="<? echo $payinfo2; ?>">
+    <? } else { ?>
+      <INPUT TYPE="text" NAME="payinfo2" SIZE=10 MAXLENGTH=9 VALUE="<? echo $payinfo2; ?>"></TD>
+    <? } ?>
+</TR><TR>
+  <TD ALIGN="right">Bank&nbsp;name</TD>
+  <TD <? echo $bgShade; ?>>
+    <? if ($ach_read_only) { echo htmlspecialchars($payname); ?>
+      <INPUT TYPE="hidden" NAME="payname" VALUE="<? echo $payname; ?>"></TD>
+    <? } else { ?>
+      <INPUT TYPE="text" SIZE=32 MAXLENGTH=80 NAME="payname" VALUE="<? echo $payname; ?>"></TD>
+    <? } ?>
+</TR><TR>
+
+  <? if ($show_paystate) { ?>
+    <TR>
+      <TD ALIGN="right">Bank state</TD>
+      <TD <? echo $bgShade; ?>>
+      <? if ($ach_read_only) { echo htmlspecialchars($paystate); ?>
+        <INPUT TYPE="hidden" NAME="paystate" VALUE="<? echo $paystate; ?>"></TD>
+      <? } else { ?>
+        <SELECT NAME="paystate">
+          <? foreach ( $states AS $s ) { ?>
+            <OPTION <? if ($s == $paystate ) { echo 'SELECTED'; } ?>><? echo $s; ?>
+          <? } ?>
+        </SELECT></TD>
+      <? } ?>
+    </TR>
+  <? } ?>
+
+  <? if ($show_ss) { ?>
+    <TR>
+      <TD ALIGN="right">Account&nbsp;holder<BR>Social&nbsp;security&nbsp;or&nbsp;tax&nbsp;ID&nbsp;#</TD>
+      <TD <? echo $bgShade; ?>>
+      <? if ($ach_read_only) { echo htmlspecialchars($ss); ?>
+        <INPUT TYPE="hidden" NAME="ss" VALUE="<? echo $ss; ?>"></TD>
+      <? } else { ?>
+        <INPUT TYPE="text" SIZE=32 MAXLENGTH=80 NAME="ss" VALUE="<? echo $ss; ?>"></TD>
+      <? } ?>
+    </TR>
+  <? } ?>
+
+  <? if ($show_stateid) { ?>
+    <TR>
+      <TD ALIGN="right">Account&nbsp;holder<BR><? echo $stateid_label; ?></TD>
+      <TD <? echo $bgShade; ?>>
+      <? if ($ach_read_only) { echo htmlspecialchars($stateid); ?>
+        <INPUT TYPE="hidden" NAME="stateid" VALUE="<? echo $stateid; ?>"></TD>
+        <TD <? echo $bgShade; ?>> <? echo $stateid_state; ?>
+          <INPUT TYPE="hidden" NAME="stateid_state" VALUE="<? echo $stateid_state; ?>"></TD>
+      <? } else { ?>
+        <INPUT TYPE="text" SIZE=32 MAXLENGTH=80 NAME="stateid" VALUE="<? echo $stateid; ?>"></TD>
+        <TD ALIGN="right"><? echo $stateid_state_label; ?></TD>
+        <TD><SELECT NAME="stateid_state">
+          <? foreach ( $states AS $s ) { ?>
+            <OPTION <? if ($s == $stateid_state ) { echo 'SELECTED'; } ?>><? echo $s; ?>
+          <? } ?>
+        </SELECT></TD>
+      <? } ?>
+    </TR>
+  <? } ?>