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<%= $url = "$selfurl?session=$session_id;action="; ''; %>
<%= include('header', 'Make a payment') %>
<FORM NAME="OneTrueForm" METHOD="POST" ACTION="<%=$selfurl%>" onSubmit="document.OneTrueForm.process.disabled=true">
<INPUT TYPE="hidden" NAME="session" VALUE="<%=$session_id%>">
<INPUT TYPE="hidden" NAME="action" VALUE="payment_results">
<TABLE BGCOLOR="#cccccc">
<TR>
<TH ALIGN="right">Amount Due</TH>
<TD COLSPAN=7>
<TABLE><TR><TD BGCOLOR="#ffffff">
$<%=sprintf("%.2f",$balance)%>
</TD></TR></TABLE>
</TD>
</TR>
<TR>
<TH ALIGN="right">Payment amount</TH>
<TD COLSPAN=7>
<TABLE><TR><TD BGCOLOR="#ffffff">
$<INPUT TYPE="text" NAME="amount" SIZE=8 VALUE="<%=sprintf("%.2f",$balance)%>">
</TD></TR></TABLE>
</TD>
</TR><TR>
<TH ALIGN="right">Card type</TH>
<TD COLSPAN=7>
<SELECT NAME="card_type"><OPTION></OPTION>
<%= foreach ( keys %card_types ) {
$selected = $card_type eq $card_types{$_} ? ' SELECTED' : '';
$OUT .= qq(<OPTION$selected VALUE="). $card_types{$_}. qq(">$_\n);
} %>
</SELECT>
</TD>
</TR>
<%= include('card') %>
<TR>
<TD COLSPAN=8>
<INPUT TYPE="checkbox" CHECKED NAME="save" VALUE="1">
Remember this information
</TD>
</TR><TR>
<TD COLSPAN=8>
<INPUT TYPE="checkbox"<%= $payby eq 'CARD' ? ' CHECKED' : '' %> NAME="auto" VALUE="1" onClick="if (this.checked) { document.OneTrueForm.save.checked=true; }">
Charge future payments to this card automatically
</TD>
</TR>
</TABLE>
<BR>
<INPUT TYPE="hidden" NAME="paybatch" VALUE="<%=$paybatch%>">
<INPUT TYPE="submit" NAME="process" VALUE="Process payment"> <!-- onClick="this.disabled=true"> -->
</FORM>
<%= include('footer') %>
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