fs_selfservice/FS-SelfService/cgi/make_ach_payment.html

   1 <%= $url = "$selfurl?session=$session_id;action="; ''; %>
   2 <%= include('header') %>
   3
   4 <FONT SIZE=4>Make a payment</FONT><BR><BR>
   5 <FORM NAME="OneTrueForm" METHOD="POST" ACTION="<%=$selfurl%>" onSubmit="document.OneTrueForm.process.disabled=true">
   6 <INPUT TYPE="hidden" NAME="session" VALUE="<%=$session_id%>">
   7 <INPUT TYPE="hidden" NAME="action" VALUE="ach_payment_results">
   8 <TABLE BGCOLOR="#cccccc">
   9 <TR>
  10   <TD ALIGN="right">Amount&nbsp;Due</TD>
  11   <TD>
  12     <TABLE><TR><TD BGCOLOR="#ffffff">
  13       $<%=sprintf("%.2f",$balance)%>
  14     </TD></TR></TABLE>
  15   </TD>
  16 </TR>
  17 <TR>
  18   <TD ALIGN="right">Payment&nbsp;amount</TD>
  19   <TD>
  20     <TABLE><TR><TD BGCOLOR="#ffffff">
  21       $<INPUT TYPE="text" NAME="amount" SIZE=8 VALUE="<%=sprintf("%.2f",$balance)%>">
  22     </TD></TR></TABLE>
  23   </TD>
  24 </TR>
  25 <%= include('check') %>
  26 <TR>
  27   <TD COLSPAN=2>
  28     <INPUT TYPE="checkbox" CHECKED NAME="save" VALUE="1">
  29     Remember this information
  30   </TD>
  31 </TR><TR>
  32   <TD COLSPAN=2>
  33     <INPUT TYPE="checkbox"<%= $payby eq 'CHEK' ? ' CHECKED' : '' %> NAME="auto" VALUE="1" onClick="if (this.checked) { document.OneTrueForm.save.checked=true; }">
  34     Charge future payments to this account automatically
  35   </TD>
  36 </TR>
  37 </TABLE>
  38 <BR>
  39 <INPUT TYPE="hidden" NAME="paybatch" VALUE="<%=$paybatch%>">
  40 <INPUT TYPE="submit" NAME="process" VALUE="Process payment"> <!-- onClick="this.disabled=true"> -->
  41 </FORM>
  42
  43 <%= include('footer') %>