prepaid card recharge

[freeside.git] / fs_selfservice / FS-SelfService / cgi / recharge_prepay.html
diff --git a/fs_selfservice/FS-SelfService/cgi/recharge_prepay.html b/fs_selfservice/FS-SelfService/cgi/recharge_prepay.html

new file mode 100644 (file)

index 0000000..f858459
--- /dev/null
+++ b/fs_selfservice/FS-SelfService/cgi/recharge_prepay.html
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+<HTML><HEAD><TITLE>MyAccount</TITLE></HEAD>
+<BODY BGCOLOR="#eeeeee"><FONT SIZE=5>MyAccount</FONT><BR><BR>
+<%= $url = "$selfurl?session=$session_id;action="; ''; %>
+<%= include('myaccount_menu') %>
+<TD VALIGN="top">
+<FONT SIZE=4>Recharge with prepaid card</FONT><BR><BR>
+<FORM NAME="OneTrueForm" METHOD="POST" ACTION="<%=$selfurl%>" onSubmit="document.OneTrueForm.process.disabled=true">
+<INPUT TYPE="hidden" NAME="session" VALUE="<%=$session_id%>">
+<INPUT TYPE="hidden" NAME="action" VALUE="recharge_results">
+<TABLE BGCOLOR="#cccccc">
+<!--
+<TR>
+  <TD ALIGN="right">Amount&nbsp;Due</TD>
+  <TD>
+    <TABLE><TR><TD BGCOLOR="#ffffff">
+      $<%=sprintf("%.2f",$balance)%>
+    </TD></TR></TABLE>
+  </TD>
+</TR>
+-->
+<TR>
+  <TD ALIGN="right">Prepaid&nbsp;card&nbsp;number</TD>
+  <TD>
+    <INPUT TYPE="text" NAME="prepaid_cardnum" SIZE=20 MAXLENGTH=19 VALUE="<%=$prepaid_cardnum%>">
+  </TD>
+</TR>
+</TABLE>
+<BR>
+<INPUT TYPE="hidden" NAME="paybatch" VALUE="<%=$paybatch%>">
+<INPUT TYPE="submit" NAME="process" VALUE="Recharge"> <!-- onClick="this.disabled=true"> -->
+</FORM>
+</TD></TR></TABLE>
+<HR>
+<FONT SIZE="-2">powered by <a href="http://www.sisd.com/freeside">freeside</a></FONT>
+</BODY></HTML>
+