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<HTML><HEAD><TITLE>MyAccount</TITLE></HEAD>
<BODY BGCOLOR="#eeeeee">
<script language="JavaScript"><!--
var mywindow = -1;
function myopen(filename,windowname,properties) {
myclose();
mywindow = window.open(filename,windowname,properties);
}
function myclose() {
if ( mywindow != -1 )
mywindow.close();
mywindow = -1
}
//--></script>
<FONT SIZE=5>MyAccount</FONT><BR><BR>
<%= $url = "$selfurl?session=$session_id;action="; ''; %>
<%= include('myaccount_menu') %>
<TD VALIGN="top">
<FONT SIZE=4>Make a payment</FONT><BR><BR>
<FORM NAME="OneTrueForm" METHOD="POST" ACTION="<%=$selfurl%>" onSubmit="document.OneTrueForm.process.disabled=true">
<INPUT TYPE="hidden" NAME="session" VALUE="<%=$session_id%>">
<INPUT TYPE="hidden" NAME="action" VALUE="ach_payment_results">
<TABLE BGCOLOR="#cccccc">
<TR>
<TD ALIGN="right">Amount Due</TD>
<TD>
<TABLE><TR><TD BGCOLOR="#ffffff">
$<%=sprintf("%.2f",$balance)%>
</TD></TR></TABLE>
</TD>
</TR>
<TR>
<TD ALIGN="right">Payment amount</TD>
<TD>
<TABLE><TR><TD BGCOLOR="#ffffff">
$<INPUT TYPE="text" NAME="amount" SIZE=8 VALUE="<%=sprintf("%.2f",$balance)%>">
</TD></TR></TABLE>
</TD>
</TR><TR>
<TD ALIGN="right">Account type</TD>
<TD>
<SELECT NAME="paytype"><OPTION></OPTION>
<%= 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>';
}
%>
<TD COLSPAN=2>
<INPUT TYPE="checkbox" CHECKED NAME="save" VALUE="1">
Remember this information
</TD>
</TR><TR>
<TD COLSPAN=2>
<INPUT TYPE="checkbox"<%= $payby eq 'CHEK' ? ' CHECKED' : '' %> NAME="auto" VALUE="1" onClick="if (this.checked) { document.OneTrueForm.save.checked=true; }">
Charge future payments to this account automatically
</TD>
</TR>
</TABLE>
<BR>
<INPUT TYPE="hidden" NAME="paybatch" VALUE="<%=$paybatch%>">
<INPUT TYPE="submit" NAME="process" VALUE="Process payment"> <!-- onClick="this.disabled=true"> -->
</FORM>
</TD></TR></TABLE>
<HR>
<FONT SIZE="-2">powered by <a href="http://www.sisd.com/freeside">freeside</a></FONT>
</BODY></HTML>
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