From a563de5fc2f42abf16fbcfda7cf5bc5f1ce794e7 Mon Sep 17 00:00:00 2001
From: Ivan Kohler <ivan@freeside.biz>
Date: Tue, 2 Jul 2013 11:53:40 -0700
Subject: selfservice, TNG, RT#22193

---
 ng_selfservice/elements/check.php | 50 +++++++++++++++++++++++++++++++++++++++
 1 file changed, 50 insertions(+)
 create mode 100644 ng_selfservice/elements/check.php

(limited to 'ng_selfservice/elements/check.php')

diff --git a/ng_selfservice/elements/check.php b/ng_selfservice/elements/check.php
new file mode 100644
index 000000000..b026c92e4
--- /dev/null
+++ b/ng_selfservice/elements/check.php
@@ -0,0 +1,50 @@
+<TR>
+  <TD ALIGN="right">Account&nbsp;type</TD>
+  <TD>
+    <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><INPUT TYPE="text" NAME="payinfo1" SIZE=10 MAXLENGTH=20 VALUE="<? echo $payinfo1; ?>"></TD>
+</TD><TR>
+  <TD ALIGN="right">ABA/Routing&nbsp;number</TD>
+  <TD><INPUT TYPE="text" NAME="payinfo2" SIZE=10 MAXLENGTH=9 VALUE="<? echo $payinfo2; ?>"></TD>
+</TR><TR>
+  <TD ALIGN="right">Bank&nbsp;name</TD>
+  <TD><INPUT TYPE="text" SIZE=32 MAXLENGTH=80 NAME="payname" VALUE="<? echo $payname; ?>"></TD>
+</TR><TR>
+
+  <? if ($show_paystate) { ?>
+       <TD ALIGN="right">Bank state</TD>
+       <TD>
+         <SELECT NAME="paystate">
+           <? foreach ( $states AS $s ) { ?>
+              <OPTION <? if ($s == $paystate ) { echo 'SELECTED'; } ?>><? echo $s; ?>
+           <? } ?>
+         </SELECT>
+       </TD>
+       </TR><TR>
+  <? } ?>
+
+  <? if ($show_ss) { ?>
+      <TD ALIGN="right">Account&nbsp;holder<BR>Social&nbsp;security&nbsp;or&nbsp;tax&nbsp;ID&nbsp;#</TD><TD>
+      <INPUT TYPE="text" SIZE=32 MAXLENGTH=80 NAME="ss" VALUE="<? echo $ss; ?>">
+      </TD></TR><TR>
+  <? } ?>
+
+  <? if ($show_stateid) { ?>
+      <TD ALIGN="right">
+      Account&nbsp;holder<BR><? echo $stateid_label; ?></TD><TD>
+      <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><TR>
+  <? } ?>
+</TR>
-- 
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