83 lines
3.2 KiB
Smarty
83 lines
3.2 KiB
Smarty
<!-- BEGIN: form -->
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<!-- BEGIN: error -->
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<p class="txtError" style="text-align: left;">{LANG_ERROR}</p>
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<!-- END: error -->
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<h3>{VAL_AMOUNT_DUE}</h3>
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<table width="100%" cellpadding="3" cellspacing="0" border="0">
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<tr align="left">
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<td colspan="4" class="tdcartTitle"><strong>{LANG_CC_INFO_TITLE}</strong></td>
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</tr>
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<tr align="left">
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<td><strong>{LANG_FIRST_NAME}</strong></td>
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<td><input type="text" name="firstName" value="{VAL_FIRST_NAME}" class="textbox" /></td>
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<td><strong>{LANG_LAST_NAME}</strong></td>
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<td><input type="text" name="lastName" value="{VAL_LAST_NAME}" class="textbox" /></td>
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</tr>
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<tr align="left">
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<td><strong>{LANG_CARD_NUMBER}</strong>
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<td colspan="3"><input type="text" name="cardNumber" value="" size="19" maxlength="19" class="textbox" /></td>
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</tr>
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<tr align="left">
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<td><strong>{LANG_EXPIRES}</strong></td>
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<td colspan="3"><input type="text" name="expirationMonth" value="" size="2" maxlength="2" class="textbox" /> / <input type="text" name="expirationYear" value="" size="2" maxlength="2" class="textbox" /> {LANG_MMYY}
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</tr>
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<tr align="left">
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<td><strong>{LANG_SECURITY_CODE}</strong>
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<td colspan="3"><input type="text" name="cvc2" value="" size="3" maxlength="3" class="textbox" /> <span onmouseover="findObj('cvv-img').src='images/general/cvv.gif'" onmouseout="findObj('cvv-img').src='images/general/px.gif'" style="cursor: pointer; cursor: hand;"> ? </span> <div id="cvv" style="position:absolute; width: 1px; height: 1px;"><img src="images/general/px.gif" border="0" id="cvv-img" alt="" /></div></td>
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</tr>
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<tr>
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<td colspan="4"> </td>
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</tr>
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<tr align="left">
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<td colspan="4" class="tdcartTitle"><strong>{LANG_CUST_INFO_TITLE}</strong></td>
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</tr>
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<tr align="left">
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<td><strong>{LANG_EMAIL}</strong></td>
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<td colspan="3"><input type="text" name="emailAddress" value="{VAL_EMAIL_ADDRESS}" size="50" class="textbox" /></td>
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</tr>
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<tr align="left">
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<td><strong>{LANG_ADDRESS}</strong></td>
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<td colspan="3"><input type="text" name="addr1" value="{VAL_ADD_1}" size="50" class="textbox" /></td>
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</tr>
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<tr align="left">
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<td> </td>
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<td colspan="3"><input type="text" name="addr2" value="{VAL_ADD_2}" size="50" class="textbox" /> {LANG_OPTIONAL}</td>
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</tr>
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<tr align="left">
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<td>
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<strong>{LANG_CITY}</strong>
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</td>
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<td colspan="3">
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<input type="text" name="city" value="{VAL_CITY}" class="textbox" />
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</td>
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</tr>
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<tr align="left">
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<td>
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<strong>{LANG_STATE}</strong>
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</td>
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<td colspan="3">
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<input type="text" name="state" value="{VAL_COUNTY}" size="2" class="textbox" />
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</td>
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</tr>
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<tr align="left">
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<td>
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<strong>{LANG_ZIPCODE}</strong>
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</td>
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<td colspan="3">
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<input type="text" name="postalCode" value="{VAL_POST_CODE}" size="10" maxlength="10" class="textbox" />
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</td>
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</tr>
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<tr align="left">
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<td><strong>{LANG_COUNTRY}</strong>
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<td colspan="3">
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<select name="country" class="textbox">
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<!-- BEGIN: repeat_countries -->
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<option value="{VAL_COUNTRY_ISO}" {COUNTRY_SELECTED}>{VAL_COUNTRY_NAME}</option>
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<!-- END: repeat_countries -->
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</select>
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</td>
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</tr>
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</table>
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<input type="hidden" name="gateway" value="{VAL_GATEWAY}" />
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<!-- END: form --> |