change service, billing, and payment info in selfservice

[freeside.git] / fs_selfservice / FS-SelfService / cgi / bill.html

diff --git a/fs_selfservice/FS-SelfService/cgi/bill.html b/fs_selfservice/FS-SelfService/cgi/bill.html
new file mode 100644 (file)
index 0000000..bbdf1f2
--- /dev/null
+++ b/fs_selfservice/FS-SelfService/cgi/bill.html
@@ -0,0 +1,7 @@
+<TR>
+  <TD ALIGN="right">P.O.&nbsp;number</TD>
+  <TD><INPUT TYPE="text" NAME="payinfo" SIZE=10 MAXLENGTH=20 VALUE="<%=$payinfo%>"></TD>
+</TR><TR>
+  <TD ALIGN="right">Attention</TD>
+  <TD><INPUT TYPE="text" SIZE=32 MAXLENGTH=80 NAME="payname" VALUE="<%=$payname%>"></TD>
+</TR>