fs_selfservice/FS-SelfService/cgi/recharge_prepay.html

   1 <%= include('header', 'Recharge with prepaid card') %>
   2
   3 <FORM NAME="OneTrueForm" METHOD="POST" ACTION="<%=$selfurl%>" onSubmit="document.OneTrueForm.process.disabled=true">
   4 <INPUT TYPE="hidden" NAME="action" VALUE="recharge_results">
   5 <TABLE BGCOLOR="#cccccc">
   6 <!--
   7 <TR>
   8   <TD ALIGN="right">Amount&nbsp;Due</TD>
   9   <TD>
  10     <TABLE><TR><TD BGCOLOR="#ffffff">
  11       $<%=sprintf("%.2f",$balance)%>
  12     </TD></TR></TABLE>
  13   </TD>
  14 </TR>
  15 -->
  16 <TR>
  17   <TD ALIGN="right">Prepaid&nbsp;card&nbsp;number</TD>
  18   <TD>
  19     <INPUT TYPE="text" NAME="prepaid_cardnum" SIZE=20 MAXLENGTH=19 VALUE="<%=$prepaid_cardnum%>">
  20   </TD>
  21 </TR>
  22 </TABLE>
  23 <BR>
  24 <INPUT TYPE="hidden" NAME="paybatch" VALUE="<%=$paybatch%>">
  25 <INPUT TYPE="submit" NAME="process" VALUE="Recharge"> <!-- onClick="this.disabled=true"> -->
  26 </FORM>
  27
  28 <%= include('footer') %>