-<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=$session_id;action="; ''; %>
-<%= include('myaccount_menu') %>
-<TD VALIGN="top">
-<FONT SIZE=4>Make a payment</FONT><BR><BR>
+<%= include('header', 'Make a payment') %>
+
<FORM NAME="OneTrueForm" METHOD="POST" ACTION="<%=$selfurl%>" onSubmit="document.OneTrueForm.process.disabled=true">
-<INPUT TYPE="hidden" NAME="session" VALUE="<%=$session_id%>">
<INPUT TYPE="hidden" NAME="action" VALUE="ach_payment_results">
<TABLE BGCOLOR="#cccccc">
<TR>
$<INPUT TYPE="text" NAME="amount" SIZE=8 VALUE="<%=sprintf("%.2f",$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>';
- }
- %>
+</TR>
+<%= include('discount_term') %>
+<%= include('check') %>
+<TR>
<TD COLSPAN=2>
- <INPUT TYPE="checkbox" CHECKED NAME="save" VALUE="1">
+ <INPUT TYPE="checkbox" <%= $save_unchecked ? '' : 'CHECKED' %> NAME="save" VALUE="1">
Remember this information
</TD>
</TR><TR>
<INPUT TYPE="hidden" NAME="paybatch" VALUE="<%=$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>
+<%= include('footer') %>