fs_selfservice/FS-SelfService/cgi/check.html


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<TR>
  <TD ALIGN="right">Account&nbsp;type</TD>
  <TD>
    <SELECT NAME="paytype">
      <%= foreach ( @paytypes ) {
            $selected = $paytype eq $_ ? ' SELECTED' : '';
            $OUT .= qq(<OPTION$selected VALUE="$_">$_\n);
      } %>
    </SELECT>
  </TD>
</TD><TR>
  <TD ALIGN="right">Account&nbsp;number</TD>
  <TD><INPUT TYPE="text" NAME="payinfo1" SIZE=10 MAXLENGTH=20 VALUE="<%=$payinfo1%>"></TD>
</TD><TR>
  <TD ALIGN="right">ABA/Routing&nbsp;number</TD>
  <TD><INPUT TYPE="text" NAME="payinfo2" SIZE=10 MAXLENGTH=9 VALUE="<%=$payinfo2%>"></TD>
</TR><TR>
  <TD ALIGN="right">Bank&nbsp;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&nbsp;holder<BR>Social&nbsp;';
      $OUT .= 'security&nbsp;or&nbsp;tax&nbsp;ID&nbsp;#</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">';
      $OUT .= qq!Account&nbsp;holder<BR>$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>';
    }
  %>
</TR>