fs_selfservice/FS-SelfService/cgi/recharge_prepay.html

   1 <HTML><HEAD><TITLE>MyAccount</TITLE></HEAD>
   2 <BODY BGCOLOR="#eeeeee"><FONT SIZE=5>MyAccount</FONT><BR><BR>
   3 <%= $url = "$selfurl?session=$session_id;action="; ''; %>
   4 <%= include('myaccount_menu') %>
   5 <TD VALIGN="top">
   6 <FONT SIZE=4>Recharge with prepaid card</FONT><BR><BR>
   7 <FORM NAME="OneTrueForm" METHOD="POST" ACTION="<%=$selfurl%>" onSubmit="document.OneTrueForm.process.disabled=true">
   8 <INPUT TYPE="hidden" NAME="session" VALUE="<%=$session_id%>">
   9 <INPUT TYPE="hidden" NAME="action" VALUE="recharge_results">
  10 <TABLE BGCOLOR="#cccccc">
  11 <!--
  12 <TR>
  13   <TD ALIGN="right">Amount&nbsp;Due</TD>
  14   <TD>
  15     <TABLE><TR><TD BGCOLOR="#ffffff">
  16       $<%=sprintf("%.2f",$balance)%>
  17     </TD></TR></TABLE>
  18   </TD>
  19 </TR>
  20 -->
  21 <TR>
  22   <TD ALIGN="right">Prepaid&nbsp;card&nbsp;number</TD>
  23   <TD>
  24     <INPUT TYPE="text" NAME="prepaid_cardnum" SIZE=20 MAXLENGTH=19 VALUE="<%=$prepaid_cardnum%>">
  25   </TD>
  26 </TR>
  27 </TABLE>
  28 <BR>
  29 <INPUT TYPE="hidden" NAME="paybatch" VALUE="<%=$paybatch%>">
  30 <INPUT TYPE="submit" NAME="process" VALUE="Recharge"> <!-- onClick="this.disabled=true"> -->
  31 </FORM>
  32 </TD></TR></TABLE>
  33 <HR>
  34 <FONT SIZE="-2">powered by <a href="http://www.sisd.com/freeside">freeside</a></FONT>
  35 </BODY></HTML>
  36