From 2c88b03550a72438bbd75ec7461d2c26fc797efc Mon Sep 17 00:00:00 2001 From: ivan Date: Sun, 18 May 2003 08:09:41 +0000 Subject: [PATCH] forgot this file --- .../FS-SelfService/cgi/make_payment.html | 118 +++++++++++++++++++++ 1 file changed, 118 insertions(+) create mode 100644 fs_selfservice/FS-SelfService/cgi/make_payment.html diff --git a/fs_selfservice/FS-SelfService/cgi/make_payment.html b/fs_selfservice/FS-SelfService/cgi/make_payment.html new file mode 100644 index 000000000..d469bddb6 --- /dev/null +++ b/fs_selfservice/FS-SelfService/cgi/make_payment.html @@ -0,0 +1,118 @@ +MyAccount +MyAccount

+<%= $url = "$selfurl?session=$session_id;action="; ''; %> +
+MyAccount
+ +		 +Make a payment

+
+ + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + + +
Amount Due +
+ $<%=sprintf("%.2f",$balance)%> +
+
Payment amount +
+ $"> +
+
Card type + +
Card number + + + + + + + + +
+ Exp. + + / + +
+
Exact name on card
Card billing address + +
Address line 2 + +
City + + + + + + + + +
+ + State + + Zip + +
+
+ + Remember this information +
+ NAME="CARD"> + Charge future payments to this card automatically +
+ +
+
+
+powered by freeside + + -- 2.11.0