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% my $auto = 0;
% if ( $payby eq 'CARD' ) {
%
%   my( $payinfo, $paycvv, $month, $year ) = ( '', '', '', '' );
%   my $payname = $cust_main->first. ' '. $cust_main->getfield('last');
%   my $location = $cust_main->bill_location;
    <TR>
      <TH ALIGN="right"><% mt('Card number') |h %></TH>
      <TD COLSPAN=7>
        <TABLE>
          <TR>
            <TD>
              <INPUT TYPE="text" NAME="payinfo" SIZE=20 MAXLENGTH=19 VALUE="<%$payinfo%>"> </TD>
            <TH><% mt('Exp.') |h %></TH>
            <TD>
              <SELECT NAME="month">
% for my $mm ( map{ sprintf( '%02d', $_ ) } (1..12) ) {
                  <OPTION value="<% $mm %>"<% $mm == $month ? ' SELECTED' : '' %>><% $mm %></OPTION>
% } 
              </SELECT>
            </TD>
            <TD> / </TD>
            <TD>
              <SELECT NAME="year">
% my @a = localtime; for my $yyyy ( $a[5]+1900 .. $a[5]+1915 ) {
                  <OPTION value="<% $yyyy %>"<% $yyyy == $year ? ' SELECTED' : '' %>><% $yyyy %></OPTION>
% } 
              </SELECT>
            </TD>
          </TR>
        </TABLE>
      </TD>
    </TR>
    <TR>
      <TH ALIGN="right"><% mt('CVV2') |h %></TH>
      <TD><INPUT TYPE="text" NAME="paycvv" VALUE="<% $paycvv %>" SIZE=4 MAXLENGTH=4>
          (<A HREF="javascript:void(0);" onClick="overlib( OLiframeContent('../docs/cvv2.html', 480, 352, 'cvv2_popup' ), CAPTION, 'CVV2 Help', STICKY, AUTOSTATUSCAP, CLOSECLICK, DRAGGABLE ); return false;"><% mt('help') |h %></A>)
      </TD>
    </TR>
    <TR>
      <TH ALIGN="right"><% mt('Exact name on card') |h %></TH>
      <TD><INPUT TYPE="text" SIZE=32 MAXLENGTH=80 NAME="payname" VALUE="<%$payname%>"></TD>
    </TR>

    <& /elements/location.html,
                  'object'         => $location,
                  'no_asterisks'   => 1,
                  'address1_label' => emt('Card billing address'),
    &>

% } elsif ( $payby eq 'CHEK' ) {
%
%   my( $account, $aba, $branch, $payname, $ss, $paytype, $paystate,
%       $stateid, $stateid_state )
%     = ( '', '', '', '', '', '', '', '', '' );
%
%  #false laziness w/{edit,view}/cust_main/billing.html
%  my $routing_label = $conf->config('echeck-country') eq 'US'
%                        ? 'ABA/Routing number'
%                        : 'Routing number';
%  my $routing_size      = $conf->config('echeck-country') eq 'CA' ? 4 : 10;
%  my $routing_maxlength = $conf->config('echeck-country') eq 'CA' ? 3 : 9;

    <INPUT TYPE="hidden" NAME="month" VALUE="12">
    <INPUT TYPE="hidden" NAME="year" VALUE="2037">
    <TR>
      <TD ALIGN="right"><% mt('Account number') |h %></TD>
      <TD><INPUT TYPE="text" SIZE=10 NAME="payinfo1" VALUE="<%$account%>"></TD>
      <TD ALIGN="right"><% mt('Type') |h %></TD>
      <TD><SELECT NAME="paytype"><% join('', map { qq!<OPTION VALUE="$_" !.($paytype eq $_ ? 'SELECTED' : '').">$_</OPTION>" } FS::cust_payby->paytypes) %></SELECT></TD>
    </TR>
    <TR>
      <TD ALIGN="right"><% mt($routing_label) |h %></TD>
      <TD>
        <INPUT TYPE="text" SIZE="<% $routing_size %>" MAXLENGTH="<% $routing_maxlength %>" NAME="payinfo2" VALUE="<%$aba%>">
        (<A HREF="javascript:void(0);" onClick="overlib( OLiframeContent('../docs/ach.html', 380, 240, 'ach_popup' ), CAPTION, 'ACH Help', STICKY, AUTOSTATUSCAP, CLOSECLICK, DRAGGABLE ); return false;"><% mt('help') |h %></A>)
      </TD>
    </TR>
%   if ( $conf->config('echeck-country') eq 'CA' ) {
      <TR>
        <TD ALIGN="right"><% mt('Branch number') |h %></TD>
        <TD>
          <INPUT TYPE="text" NAME="payinfo3" VALUE="<%$branch%>" SIZE=6 MAXLENGTH=5>
        </TD>
      </TR>
%   }
    <TR>
      <TD ALIGN="right"><% mt('Bank name') |h %></TD>
      <TD><INPUT TYPE="text" NAME="payname" VALUE="<%$payname%>"></TD>
    </TR>

%   if ( $conf->exists('show_bankstate') ) {
      <TR>
        <TD ALIGN="right"><% mt('Bank state') |h %></TD>
        <TD><& /elements/select-state.html,
                         'disable_empty' => 0,
                         'empty_label'   => emt('(choose)'),
                         'state'         => $paystate,
                         'country'       => $cust_main->country,
                         'prefix'        => 'pay',
            &>
        </TD>
      </TR>
%   } else {
      <INPUT TYPE="hidden" NAME="paystate" VALUE="<% $paystate %>">
%   }

%   if ( $conf->exists('show_ss') ) {
      <TR>
        <TD ALIGN="right">
          <% mt('Account holder') |h %><BR>
          <% mt('Social security or tax ID #') |h %> 
        </TD>
        <TD><INPUT TYPE="text" NAME="ss" VALUE="<% $ss %>"></TD>
      </TR>
%   } else {
      <INPUT TYPE="hidden" NAME="ss" VALUE="<% $ss %>"></TD>
%   }

%   if ( $conf->exists('show_stateid') ) {
      <TR>
        <TD ALIGN="right">
          <% mt('Account holder') |h %><BR>
          <% mt("Driver's license or state ID #") |h %> 
        </TD>
        <TD><INPUT TYPE="text" NAME="stateid" VALUE="<% $stateid %>"></TD>
        <TD ALIGN="right"><% mt('State') |h %></TD>
        <TD><& /elements/select-state.html,
                         'disable_empty' => 0,
                         'empty_label'   => emt('(choose)'),
                         'state'         => $stateid_state,
                         'country'       => $cust_main->country,
                         'prefix'        => 'stateid_',
            &>
        </TD>
      </TR>
%   } else {
      <INPUT TYPE="hidden" NAME="stateid" VALUE="<% $stateid %>">
      <INPUT TYPE="hidden" NAME="stateid_state" VALUE="<% $stateid_state %>">
%   }

% } #end CARD/CHEK-specific section


<TR>
  <TD COLSPAN=8>
    <INPUT TYPE="checkbox" CHECKED NAME="save" VALUE="1">
    <% mt('Remember this information') |h %>
  </TD>
</TR>

<TR>
  <TD COLSPAN=8>
    <INPUT TYPE="checkbox"<% $auto ? ' CHECKED' : '' %> NAME="auto" VALUE="1" onClick="if (this.checked) { document.OneTrueForm.save.checked=true; }">
    <% mt("Charge future payments to this [_1] automatically",$type{$payby}) |h %> 
% if ( @cust_payby ) {
    <% mt('as') |h %>
    <SELECT NAME="weight">
%     for ( 1 .. 1+scalar(grep { $_->payby =~ /^(CARD|CHEK)$/ } @cust_payby) ) {
        <OPTION VALUE="<%$_%>"><% mt( $weight{$_} ) |h %></OPTION>
%     }
    </SELECT>
% } else {
    <INPUT TYPE="hidden" NAME="weight" VALUE="1">
% }
  </TD>
</TR>

<%once>

my %weight = (
  1 => 'Primary',
  2 => 'Secondary',
  3 => 'Tertiary',
  4 => 'Fourth',
  5 => 'Fifth',
  6 => 'Sixth',
  7 => 'Seventh',
);

</%once>

<%init>

my %opt = @_;

my @cust_payby = @{$opt{cust_payby}};

my %type = ( 'CARD' => 'credit card',
             'CHEK' => 'electronic check (ACH)',
           );

$cgi->param('payby') =~ /^(CARD|CHEK)$/
  or die "unknown payby ". $cgi->param('payby');
my $payby = $1;

$cgi->param('custnum') =~ /^(\d+)$/
  or die "illegal custnum ". $cgi->param('custnum');
my $custnum = $1;

my $cust_main = qsearchs( 'cust_main', { 'custnum'=>$custnum } );
die "unknown custnum $custnum" unless $cust_main;

my $balance = $cust_main->balance;

my $payinfo = '';

my $conf = new FS::Conf;

#false laziness w/selfservice make_payment.html shortcut for one-country
my %states = map { $_->state => 1 }
               qsearch('cust_main_county', {
                 'country' => $conf->config('countrydefault') || 'US'
               } );
my @states = sort { $a cmp $b } keys %states;

</%init>