1 <HTML><HEAD><TITLE>MyAccount</TITLE></HEAD>
2 <BODY BGCOLOR="#eeeeee"><FONT SIZE=5>MyAccount</FONT><BR><BR>
3 <%= $url = "$selfurl?session=$session_id;action="; ''; %>
4 <TABLE BORDER=0 CELLPADDING=4><TR><TD VALIGN="top" HEIGHT=384 BGCOLOR="#dddddd">
5 <A HREF="<%= $url %>myaccount">MyAccount</A><BR>
6 <!-- <A HREF="<%= $url %>other">SomethingElse</A><BR> -->
8 <FONT SIZE=4>Make a payment</FONT><BR><BR>
9 <FORM NAME="OneTrueForm" METHOD="POST" ACTION="<%=$selfurl%>" onSubmit="document.OneTrueForm.process.disabled=true">
10 <INPUT TYPE="hidden" NAME="session" VALUE="<%=$session_id%>">
11 <INPUT TYPE="hidden" NAME="action" VALUE="payment_results">
12 <TABLE BGCOLOR="#cccccc">
14 <TD ALIGN="right">Amount Due</TD>
16 <TABLE><TR><TD BGCOLOR="#ffffff">
17 $<%=sprintf("%.2f",$balance)%>
22 <TD ALIGN="right">Payment amount</TD>
24 <TABLE><TR><TD BGCOLOR="#ffffff">
25 $<INPUT TYPE="text" NAME="amount" SIZE=8 VALUE="<%=sprintf("%.2f",$balance)%>">
29 <TD ALIGN="right">Card type</TD>
31 <SELECT NAME="card_type"><OPTION></OPTION>
32 <%= foreach ( keys %card_types ) {
33 $selected = $card_type eq $card_types{$_} ? ' SELECTED' : '';
34 $OUT .= qq(<OPTION$selected VALUE="). $card_types{$_}. qq(">$_\n);
39 <TD ALIGN="right">Card number</TD>
44 <INPUT TYPE="text" NAME="payinfo" SIZE=20 MAXLENGTH=19 VALUE="<%=$payinfo%>"> </TD>
48 <%= for ( ( map "0$_", 1 .. 9 ), 11, 12 ) {
49 $OUT .= '<OPTION'. ($_ eq $month ? ' SELECTED' : ''). ">$_\n";
56 <%= for ( 2003 .. 2012 ) {
57 $OUT .= '<OPTION'. ($_ eq $year ? ' SELECTED' : ''). ">$_\n";
65 <TD ALIGN="right">Exact name on card</TD>
66 <TD><INPUT TYPE="text" SIZE=32 MAXLENGTH=80 NAME="payname" VALUE="<%=$payname%>"></TD>
68 <TD ALIGN="right">Card billing address</TD>
70 <INPUT TYPE="text" SIZE=40 MAXLENGTH=80 NAME="address1" VALUE="<%=$address1%>">
73 <TD ALIGN="right">Address line 2</TD>
75 <INPUT TYPE="text" SIZE=40 MAXLENGTH=80 NAME="address2" VALUE="<%=$address2%>">
78 <TD ALIGN="right">City</TD>
83 <INPUT TYPE="text" NAME="city" SIZE="12" MAXLENGTH=80 VALUE="<%=$city%>">
89 $OUT .= '<OPTION'. ($_ eq $state ? ' SELECTED' : '' ). ">$_\n";
95 <INPUT TYPE="text" NAME="zip" SIZE=11 MAXLENGTH=10 VALUE="<%=$zip%>">
102 <INPUT TYPE="checkbox" CHECKED NAME="save" VALUE="1">
103 Remember this information
107 <INPUT TYPE="checkbox"<%= $payby eq 'CARD' ? ' CHECKED' : '' %> NAME="auto" VALUE="1" onClick="if (this.checked) { document.OneTrueForm.save.checked=true; }">
108 Charge future payments to this card automatically
113 <INPUT TYPE="hidden" NAME="paybatch" VALUE="<%=$paybatch%>">
114 <INPUT TYPE="submit" NAME="process" VALUE="Process payment"> <!-- onClick="this.disabled=true"> -->
118 <FONT SIZE="-2">powered by <a href="http://www.sisd.com/freeside">freeside</a></FONT>