--- /dev/null
+<TR>
+ <TD ALIGN="right">Account type</TD>
+ <TD>
+ <SELECT NAME="paytype">
+ <? foreach ( $paytypes AS $pt ) { ?>
+ <OPTION <? if ($pt == $paytype ) { echo 'SELECTED'; } ?> VALUE="<? echo $pt; ?>"><? echo $pt; ?>
+ <? } ?>
+ </SELECT>
+ </TD>
+</TR><TR>
+ <TD ALIGN="right">Account number</TD>
+ <TD><INPUT TYPE="text" NAME="payinfo1" SIZE=10 MAXLENGTH=20 VALUE="<? echo $payinfo1; ?>"></TD>
+</TD><TR>
+ <TD ALIGN="right">ABA/Routing number</TD>
+ <TD><INPUT TYPE="text" NAME="payinfo2" SIZE=10 MAXLENGTH=9 VALUE="<? echo $payinfo2; ?>"></TD>
+</TR><TR>
+ <TD ALIGN="right">Bank name</TD>
+ <TD><INPUT TYPE="text" SIZE=32 MAXLENGTH=80 NAME="payname" VALUE="<? echo $payname; ?>"></TD>
+</TR><TR>
+
+ <? if ($show_paystate) { ?>
+ <TD ALIGN="right">Bank state</TD>
+ <TD>
+ <SELECT NAME="paystate">
+ <? foreach ( $states AS $s ) { ?>
+ <OPTION <? if ($s == $paystate ) { echo 'SELECTED'; } ?>><? echo $s; ?>
+ <? } ?>
+ </SELECT>
+ </TD>
+ </TR><TR>
+ <? } ?>
+
+ <? if ($show_ss) { ?>
+ <TD ALIGN="right">Account holder<BR>Social security or tax ID #</TD><TD>
+ <INPUT TYPE="text" SIZE=32 MAXLENGTH=80 NAME="ss" VALUE="<? echo $ss; ?>">
+ </TD></TR><TR>
+ <? } ?>
+
+ <? if ($show_stateid) { ?>
+ <TD ALIGN="right">
+ Account holder<BR><? echo $stateid_label; ?></TD><TD>
+ <INPUT TYPE="text" SIZE=32 MAXLENGTH=80 NAME="stateid" VALUE="<? echo $stateid; ?>"></TD>
+ <TD ALIGN="right"><? echo $stateid_state_label; ?></TD>
+ <TD><SELECT NAME="stateid_state">
+ <? foreach ( $states AS $s ) { ?>
+ <OPTION <? if ($s == $stateid_state ) { echo 'SELECTED'; } ?>><? echo $s; ?>
+ <? } ?>
+ </SELECT></TD></TR><TR>
+ <? } ?>
+</TR>