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<TR>
<TD ALIGN="right">Account type</TD>
<TD <%= ($ach_read_only ? ' BGCOLOR="#ffffff"' : '') %> >
<%=
if ($ach_read_only) {
$OUT = $paytype . '<INPUT TYPE="hidden" NAME="paytype" VALUE="' . $paytype . '">';
} else {
$OUT .= '<SELECT NAME="paytype">';
foreach ( @paytypes ) {
$selected = $paytype eq $_ ? ' SELECTED' : '';
$OUT .= qq(<OPTION$selected VALUE="$_">$_\n);
}
$OUT .= '</SELECT>';
}
%>
</TD>
</TR><TR>
<TD ALIGN="right">Account number</TD>
<TD <%= ($ach_read_only ? ' BGCOLOR="#ffffff"' : '') %> >
<%= if ($ach_read_only) {
$OUT = qq! $payinfo1 <INPUT TYPE="hidden" NAME="payinfo1" VALUE="$payinfo1"> !;
} else {
$OUT = qq! <INPUT TYPE="text" NAME="payinfo1" SIZE=10 MAXLENGTH=20 VALUE="$payinfo1"> !;
}
%>
</TD>
</TR><TR>
<TD ALIGN="right">ABA/Routing number</TD>
<TD <%= ($ach_read_only ? ' BGCOLOR="#ffffff"' : '') %> >
<%=
if ($ach_read_only) {
$OUT = qq! $payinfo2 <INPUT TYPE="hidden" NAME="payinfo2" VALUE="$payinfo2"> !;
} else {
$OUT = qq! <INPUT TYPE="text" NAME="payinfo2" SIZE=10 MAXLENGTH=20 VALUE="$payinfo2"> !;
}
%>
</TD>
</TR><TR>
<TD ALIGN="right">Bank name</TD>
<TD <%= ($ach_read_only ? ' BGCOLOR="#ffffff"' : '') %> >
<%=
if ($ach_read_only) {
$OUT = qq! $payname <INPUT TYPE="hidden" NAME="payname" VALUE="$payname"> !;
} else {
$OUT = qq! <INPUT TYPE="text" NAME="payname" SIZE=10 MAXLENGTH=20 VALUE="$payname"> !;
}
%>
</TD>
</TR>
<%=
$OUT = '';
if ($show_paystate) {
$OUT .= '<TR><TD ALIGN="right">Bank state</TD><TD' . ($ach_read_only ? ' BGCOLOR="#ffffff"' : '') . '>';
if ($ach_read_only) {
$OUT .= qq! $paystate <INPUT TYPE="hidden" NAME="paystate" VALUE="$paystate"> !;
} else {
$OUT .= '<SELECT NAME="paystate">';
for ( @states ) {
$OUT .= '<OPTION'. ($_ eq $paystate ? ' SELECTED' : '' ). ">$_\n";
}
$OUT .= '</SELECT>';
}
$OUT .= '</TD></TR>';
}
%>
<%=
$OUT = '';
if ($show_ss) {
$OUT .= '<TR><TD ALIGN="right">Account holder<BR>Social ';
$OUT .= 'security or tax ID #</TD><TD' . ($ach_read_only ? ' BGCOLOR="#ffffff"' : '') . '>';
if ($ach_read_only) {
$OUT .= qq! $ss <INPUT TYPE="hidden" NAME="ss" VALUE="$ss">!;
} else {
$OUT .= qq!<INPUT TYPE="text" SIZE=32 MAXLENGTH=80 NAME="ss" VALUE="$ss">!;
}
$OUT .= '</TD></TR>';
}
%>
<%=
$OUT = '';
if ($show_stateid) {
$OUT .= qq!<TR><TD ALIGN="right">Account holder<BR>$stateid_label</TD>!;
$OUT .= '<TD' . ($ach_read_only ? ' BGCOLOR="#ffffff"' : '') . '>';
if ($ach_read_only) {
$OUT .= qq! $stateid <INPUT TYPE="hidden" NAME="stateid" VALUE="$stateid">!;
} else {
$OUT .= qq!<INPUT TYPE="text" SIZE=32 MAXLENGTH=80 NAME="stateid" VALUE="$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>';
}
$OUT .='</TD></TR>';
}
%>
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