fs_selfservice/FS-SelfService/cgi/recharge_prepay.html

   1 <%= $url = "$selfurl?session=$session_id;action="; ''; %>
   2 <%= include('header', 'Recharge with prepaid card') %>
   3
   4 <FORM NAME="OneTrueForm" METHOD="POST" ACTION="<%=$selfurl%>" onSubmit="document.OneTrueForm.process.disabled=true">
   5 <INPUT TYPE="hidden" NAME="session" VALUE="<%=$session_id%>">
   6 <INPUT TYPE="hidden" NAME="action" VALUE="recharge_results">
   7 <TABLE BGCOLOR="#cccccc">
   8 <!--
   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 -->
  18 <TR>
  19   <TD ALIGN="right">Prepaid&nbsp;card&nbsp;number</TD>
  20   <TD>
  21     <INPUT TYPE="text" NAME="prepaid_cardnum" SIZE=20 MAXLENGTH=19 VALUE="<%=$prepaid_cardnum%>">
  22   </TD>
  23 </TR>
  24 </TABLE>
  25 <BR>
  26 <INPUT TYPE="hidden" NAME="paybatch" VALUE="<%=$paybatch%>">
  27 <INPUT TYPE="submit" NAME="process" VALUE="Recharge"> <!-- onClick="this.disabled=true"> -->
  28 </FORM>
  29
  30 <%= include('footer') %>