-</TD><TR>
- <TD ALIGN="right">Card number</TD>
- <TD>
- <TABLE>
- <TR>
- <TD>
- <INPUT TYPE="text" NAME="payinfo" SIZE=20 MAXLENGTH=19 VALUE="<%=$payinfo%>"> </TD>
- <TD>Exp.</TD>
- <TD>
- <SELECT NAME="month">
- <%= for ( ( map "0$_", 1 .. 9 ), 11, 12 ) {
- $OUT .= '<OPTION'. ($_ == $month ? ' SELECTED' : ''). ">$_\n";
- } %>
- </SELECT>
- </TD>
- <TD> / </TD>
- <TD>
- <SELECT NAME="year">
- <%= my @a = localtime; for ( $a[5]+1900 .. $a[5]+1915 ) {
- $OUT .= '<OPTION'. ($_ == $year ? ' SELECTED' : ''). ">$_\n";
- } %>
- </SELECT>
- </TD>
- </TR>
- </TABLE>
- </TD>
-</TR><TR>
- <TD ALIGN="right">Exact name on card</TD>
- <TD><INPUT TYPE="text" SIZE=32 MAXLENGTH=80 NAME="payname" VALUE="<%=$payname%>"></TD>
-</TR><TR>
- <TD ALIGN="right">Card billing address</TD>
- <TD>
- <INPUT TYPE="text" SIZE=40 MAXLENGTH=80 NAME="address1" VALUE="<%=$address1%>">
- </TD>
-</TR><TR>
- <TD ALIGN="right">Address line 2</TD>
- <TD>
- <INPUT TYPE="text" SIZE=40 MAXLENGTH=80 NAME="address2" VALUE="<%=$address2%>">
- </TD>
-</TR><TR>
- <TD ALIGN="right">City</TD>
- <TD>
- <TABLE>
- <TR>
- <TD>
- <INPUT TYPE="text" NAME="city" SIZE="12" MAXLENGTH=80 VALUE="<%=$city%>">
- </TD>
- <TD>State</TD>
- <TD>
- <SELECT NAME="state">
- <%= for ( @states ) {
- $OUT .= '<OPTION'. ($_ eq $state ? ' SELECTED' : '' ). ">$_\n";
- } %>
- </SELECT>
- </TD>
- <TD>Zip</TD>
- <TD>
- <INPUT TYPE="text" NAME="zip" SIZE=11 MAXLENGTH=10 VALUE="<%=$zip%>">
- </TD>
- </TR>
- </TABLE>
- </TD>
-</TR><TR>
- <TD COLSPAN=2>
- <INPUT TYPE="checkbox" CHECKED NAME="save" VALUE="1">
- Remember this information