+<HTML><HEAD><TITLE>MyAccount</TITLE></HEAD>
+<BODY BGCOLOR="#eeeeee">
+<script language="JavaScript"><!--
+ var mywindow = -1;
+ function myopen(filename,windowname,properties) {
+ myclose();
+ mywindow = window.open(filename,windowname,properties);
+ }
+ function myclose() {
+ if ( mywindow != -1 )
+ mywindow.close();
+ mywindow = -1
+ }
+//--></script>
+<FONT SIZE=5>MyAccount</FONT><BR><BR>
+<%= $url = "$selfurl?session=$session_id;action="; ''; %>
+<%= include('myaccount_menu') %>
+<TD VALIGN="top">
+<FONT SIZE=4>Make a payment</FONT><BR><BR>
+<FORM NAME="OneTrueForm" METHOD="POST" ACTION="<%=$selfurl%>" onSubmit="document.OneTrueForm.process.disabled=true">
+<INPUT TYPE="hidden" NAME="session" VALUE="<%=$session_id%>">
+<INPUT TYPE="hidden" NAME="action" VALUE="ach_payment_results">
+<TABLE BGCOLOR="#cccccc">
+<TR>
+ <TD ALIGN="right">Amount Due</TD>
+ <TD>
+ <TABLE><TR><TD BGCOLOR="#ffffff">
+ $<%=sprintf("%.2f",$balance)%>
+ </TD></TR></TABLE>
+ </TD>
+</TR>
+<TR>
+ <TD ALIGN="right">Payment amount</TD>
+ <TD>
+ <TABLE><TR><TD BGCOLOR="#ffffff">
+ $<INPUT TYPE="text" NAME="amount" SIZE=8 VALUE="<%=sprintf("%.2f",$balance)%>">
+ </TD></TR></TABLE>
+ </TD>
+</TR><TR>
+ <TD ALIGN="right">Account type</TD>
+ <TD>
+ <SELECT NAME="paytype"><OPTION></OPTION>
+ <%= foreach ( @paytypes ) {
+ $selected = $paytype eq $_ ? ' SELECTED' : '';
+ $OUT .= qq(<OPTION$selected VALUE="$_">$_\n);
+ } %>
+ </SELECT>
+ </TD>
+</TD><TR>
+ <TD ALIGN="right">Account number</TD>
+ <TD><INPUT TYPE="text" NAME="payinfo1" SIZE=10 MAXLENGTH=20 VALUE="<%=$payinfo1%>"></TD>
+</TD><TR>
+ <TD ALIGN="right">ABA/Routing number</TD>
+ <TD><INPUT TYPE="text" NAME="payinfo2" SIZE=10 MAXLENGTH=9 VALUE="<%=$payinfo2%>"></TD>
+</TR><TR>
+ <TD ALIGN="right">Bank name</TD>
+ <TD><INPUT TYPE="text" SIZE=32 MAXLENGTH=80 NAME="payname" VALUE="<%=$payname%>"></TD>
+</TR><TR>
+ <%=
+ $OUT = '';
+ if ($show_paystate) {
+ $OUT .= qq!<TD ALIGN="right">Bank state</TD><TD><SELECT NAME="paystate">!;
+ for ( @states ) {
+ $OUT .= '<OPTION'. ($_ eq $paystate ? ' SELECTED' : '' ). ">$_\n";
+ }
+ $OUT .= '</SELECT></TD></TR><TR>';
+ }
+ %>
+ <%=
+ $OUT = '';
+ if ($show_ss) {
+ $OUT .= '<TD ALIGN="right">Account holder<BR>Social ';
+ $OUT .= 'security or tax ID #</TD><TD>';
+ $OUT .= qq!<INPUT TYPE="text" SIZE=32 MAXLENGTH=80 NAME="ss" VALUE="$ss">!;
+ $OUT .= '</TD></TR><TR>';
+ }
+ %>
+ <%=
+ $OUT = '';
+ if ($show_stateid) {
+ $OUT .= '<TD ALIGN="right">';
+ $OUT .= qq!Account holder<BR>$stateid_label</TD><TD>!;
+ $OUT .= qq!<INPUT TYPE="text" SIZE=32 MAXLENGTH=80 NAME="stateid" VALUE="$stateid"></TD>!;
+ $OUT .= qq!<TD ALIGN="right">$stateid_state_label</TD>!;
+ $OUT .= '<TD><SELECT NAME="stateid_state">';
+ for ( @states ) {
+ $OUT .= '<OPTION'. ($_ eq $stateid_state ? ' SELECTED' : '' ). ">$_\n";
+ }
+ $OUT .='</SELECT></TD></TR><TR>';
+ }
+ %>
+ <TD COLSPAN=2>
+ <INPUT TYPE="checkbox" CHECKED NAME="save" VALUE="1">
+ Remember this information
+ </TD>
+</TR><TR>
+ <TD COLSPAN=2>
+ <INPUT TYPE="checkbox"<%= $payby eq 'CHEK' ? ' CHECKED' : '' %> NAME="auto" VALUE="1" onClick="if (this.checked) { document.OneTrueForm.save.checked=true; }">
+ Charge future payments to this account automatically
+ </TD>
+</TR>
+</TABLE>
+<BR>
+<INPUT TYPE="hidden" NAME="paybatch" VALUE="<%=$paybatch%>">
+<INPUT TYPE="submit" NAME="process" VALUE="Process payment"> <!-- 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>
+