+% my $auto = 0;
+% if ( $payby eq 'CARD' ) {
+%
+% my( $payinfo, $paycvv, $month, $year ) = ( '', '', '', '' );
+% my $payname = $cust_main->first. ' '. $cust_main->getfield('last');
+% my $location = $cust_main->bill_location;
+
+ <TR>
+ <TH ALIGN="right"><% mt('Card number') |h %></TH>
+ <TD COLSPAN=7>
+ <TABLE>
+ <TR>
+ <TD>
+ <INPUT TYPE="text" NAME="payinfo" SIZE=20 MAXLENGTH=19 VALUE="<%$payinfo%>"> </TD>
+ <TH><% mt('Exp.') |h %></TH>
+ <TD>
+ <SELECT NAME="month">
+% for ( ( map "0$_", 1 .. 9 ), 10 .. 12 ) {
+
+ <OPTION<% $_ == $month ? ' SELECTED' : '' %>><% $_ %>
+% }
+
+ </SELECT>
+ </TD>
+ <TD> / </TD>
+ <TD>
+ <SELECT NAME="year">
+% my @a = localtime; for ( $a[5]+1900 .. $a[5]+1915 ) {
+
+ <OPTION<% $_ == $year ? ' SELECTED' : '' %>><% $_ %>
+% }
+
+ </SELECT>
+ </TD>
+ </TR>
+ </TABLE>
+ </TD>
+ </TR>
+ <TR>
+ <TH ALIGN="right"><% mt('CVV2') |h %></TH>
+ <TD><INPUT TYPE="text" NAME="paycvv" VALUE="<% $paycvv %>" SIZE=4 MAXLENGTH=4>
+ (<A HREF="javascript:void(0);" onClick="overlib( OLiframeContent('../docs/cvv2.html', 480, 352, 'cvv2_popup' ), CAPTION, 'CVV2 Help', STICKY, AUTOSTATUSCAP, CLOSECLICK, DRAGGABLE ); return false;"><% mt('help') |h %></A>)
+ </TD>
+ </TR>
+ <TR>
+ <TH ALIGN="right"><% mt('Exact name on card') |h %></TH>
+ <TD><INPUT TYPE="text" SIZE=32 MAXLENGTH=80 NAME="payname" VALUE="<%$payname%>"></TD>
+ </TR>
+
+ <& /elements/location.html,
+ 'object' => $location,
+ 'no_asterisks' => 1,
+ 'address1_label' => emt('Card billing address'),
+ &>
+
+% } elsif ( $payby eq 'CHEK' ) {
+%
+% my( $account, $aba, $branch, $payname, $ss, $paytype, $paystate,
+% $stateid, $stateid_state )
+% = ( '', '', '', '', '', '', '', '', '' );
+%
+% #false laziness w/{edit,view}/cust_main/billing.html
+% my $routing_label = $conf->config('echeck-country') eq 'US'
+% ? 'ABA/Routing number'
+% : 'Routing number';
+% my $routing_size = $conf->config('echeck-country') eq 'CA' ? 4 : 10;
+% my $routing_maxlength = $conf->config('echeck-country') eq 'CA' ? 3 : 9;
+
+ <INPUT TYPE="hidden" NAME="month" VALUE="12">
+ <INPUT TYPE="hidden" NAME="year" VALUE="2037">
+ <TR>
+ <TD ALIGN="right"><% mt('Account number') |h %></TD>
+ <TD><INPUT TYPE="text" SIZE=10 NAME="payinfo1" VALUE="<%$account%>"></TD>
+ <TD ALIGN="right"><% mt('Type') |h %></TD>
+ <TD><SELECT NAME="paytype"><% join('', map { qq!<OPTION VALUE="$_" !.($paytype eq $_ ? 'SELECTED' : '').">$_</OPTION>" } FS::cust_payby->paytypes) %></SELECT></TD>
+ </TR>
+ <TR>
+ <TD ALIGN="right"><% mt($routing_label) |h %></TD>
+ <TD>
+ <INPUT TYPE="text" SIZE="<% $routing_size %>" MAXLENGTH="<% $routing_maxlength %>" NAME="payinfo2" VALUE="<%$aba%>">
+ (<A HREF="javascript:void(0);" onClick="overlib( OLiframeContent('../docs/ach.html', 380, 240, 'ach_popup' ), CAPTION, 'ACH Help', STICKY, AUTOSTATUSCAP, CLOSECLICK, DRAGGABLE ); return false;"><% mt('help') |h %></A>)
+ </TD>
+ </TR>
+% if ( $conf->config('echeck-country') eq 'CA' ) {
+ <TR>
+ <TD ALIGN="right"><% mt('Branch number') |h %></TD>
+ <TD>
+ <INPUT TYPE="text" NAME="payinfo3" VALUE="<%$branch%>" SIZE=6 MAXLENGTH=5>
+ </TD>
+ </TR>
+% }
+ <TR>
+ <TD ALIGN="right"><% mt('Bank name') |h %></TD>
+ <TD><INPUT TYPE="text" NAME="payname" VALUE="<%$payname%>"></TD>
+ </TR>
+
+% if ( $conf->exists('show_bankstate') ) {
+ <TR>
+ <TD ALIGN="right"><% mt('Bank state') |h %></TD>
+ <TD><& /elements/select-state.html,
+ 'disable_empty' => 0,
+ 'empty_label' => emt('(choose)'),
+ 'state' => $paystate,
+ 'country' => $cust_main->country,
+ 'prefix' => 'pay',
+ &>
+ </TD>
+ </TR>
+% } else {
+ <INPUT TYPE="hidden" NAME="paystate" VALUE="<% $paystate %>">
+% }
+
+% if ( $conf->exists('show_ss') ) {
+ <TR>
+ <TD ALIGN="right">
+ <% mt('Account holder') |h %><BR>
+ <% mt('Social security or tax ID #') |h %>
+ </TD>
+ <TD><INPUT TYPE="text" NAME="ss" VALUE="<% $ss %>"></TD>
+ </TR>
+% } else {
+ <INPUT TYPE="hidden" NAME="ss" VALUE="<% $ss %>"></TD>
+% }
+
+% if ( $conf->exists('show_stateid') ) {
+ <TR>
+ <TD ALIGN="right">
+ <% mt('Account holder') |h %><BR>
+ <% mt("Driver's license or state ID #") |h %>
+ </TD>
+ <TD><INPUT TYPE="text" NAME="stateid" VALUE="<% $stateid %>"></TD>
+ <TD ALIGN="right"><% mt('State') |h %></TD>
+ <TD><& /elements/select-state.html,
+ 'disable_empty' => 0,
+ 'empty_label' => emt('(choose)'),
+ 'state' => $stateid_state,
+ 'country' => $cust_main->country,
+ 'prefix' => 'stateid_',
+ &>
+ </TD>
+ </TR>
+% } else {
+ <INPUT TYPE="hidden" NAME="stateid" VALUE="<% $stateid %>">
+ <INPUT TYPE="hidden" NAME="stateid_state" VALUE="<% $stateid_state %>">
+% }
+
+% } #end CARD/CHEK-specific section
+
+
+<TR>
+ <TD COLSPAN=8>
+ <INPUT TYPE="checkbox" CHECKED NAME="save" VALUE="1">
+ <% mt('Remember this information') |h %>
+ </TD>
+</TR>
+
+<TR>
+ <TD COLSPAN=8>
+ <INPUT TYPE="checkbox"<% $auto ? ' CHECKED' : '' %> NAME="auto" VALUE="1" onClick="if (this.checked) { document.OneTrueForm.save.checked=true; }">
+ <% mt("Charge future payments to this [_1] automatically",$type{$payby}) |h %>
+% if ( @cust_payby ) {
+ <% mt('as') |h %>
+ <SELECT NAME="weight">
+% for ( 1 .. 1+scalar(grep { $_->payby =~ /^(CARD|CHEK)$/ } @cust_payby) ) {
+ <OPTION VALUE="<%$_%>"><% mt( $weight{$_} ) |h %>
+% }
+ </SELECT>
+% } else {
+ <INPUT TYPE="hidden" NAME="weight" VALUE="1">
+% }
+ </TD>
+</TR>
+
+<%once>
+
+my %weight = (
+ 1 => 'Primary',
+ 2 => 'Secondary',
+ 3 => 'Tertiary',
+ 4 => 'Fourth',
+ 5 => 'Fifth',
+ 6 => 'Sixth',
+ 7 => 'Seventh',
+);
+
+</%once>
+
+<%init>
+
+my %opt = @_;
+
+my @cust_payby = @{$opt{cust_payby}};
+
+my %type = ( 'CARD' => 'credit card',
+ 'CHEK' => 'electronic check (ACH)',
+ );
+
+$cgi->param('payby') =~ /^(CARD|CHEK)$/
+ or die "unknown payby ". $cgi->param('payby');
+my $payby = $1;
+
+$cgi->param('custnum') =~ /^(\d+)$/
+ or die "illegal custnum ". $cgi->param('custnum');
+my $custnum = $1;
+
+my $cust_main = qsearchs( 'cust_main', { 'custnum'=>$custnum } );
+die "unknown custnum $custnum" unless $cust_main;
+
+my $balance = $cust_main->balance;
+
+my $payinfo = '';
+
+my $conf = new FS::Conf;
+
+#false laziness w/selfservice make_payment.html shortcut for one-country
+my %states = map { $_->state => 1 }
+ qsearch('cust_main_county', {
+ 'country' => $conf->config('countrydefault') || 'US'
+ } );
+my @states = sort { $a cmp $b } keys %states;
+
+</%init>
\ No newline at end of file