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<TR>
<TD ALIGN="right">Account 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 number</TD>
<TD><INPUT TYPE="text" NAME="payinfo1" SIZE=10 MAXLENGTH=20 VALUE="<%=$payinfo1%>"></TD>
</TD><TR>
<TD ALIGN="right">ABA/Routing number</TD>
<TD><INPUT TYPE="text" NAME="payinfo2" SIZE=10 MAXLENGTH=9 VALUE="<%=$payinfo2%>"></TD>
</TR><TR>
<TD ALIGN="right">Bank 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 holder<BR>Social ';
$OUT .= 'security or tax ID #</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">';
$OUT .= qq!Account holder<BR>$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>
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