fs_selfservice/FS-SelfService/cgi/make_ach_payment.html

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