99 lines
3.5 KiB
Smarty
99 lines
3.5 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_TYPE}</strong>
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<td colspan="3">
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<select name="cardType" class="textbox">
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<!-- BEGIN: repeat_cards -->
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<option value="{VAL_CARD_TYPE}" {CARD_SELECTED}>{VAL_CARD_NAME}</option>
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<!-- END: repeat_cards -->
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</select>
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</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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<!-- BEGIN: issue_info -->
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<tr align="left">
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<td><strong>{LANG_ISSUE_DATE}</strong>
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<td colspan="3"><input type="text" name="issueMonth" value="" size="2" maxlength="2" class="textbox" />
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/
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<input type="text" name="issueYear" value="" size="2" maxlength="2" class="textbox" />
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{LANG_MMYY} </td>
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</tr>
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<tr align="left">
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<td><strong>{LANG_ISSUE_NO}</strong>
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<td colspan="3"><input type="text" name="issueNo" value="" size="4" maxlength="4" class="textbox" /></td>
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</tr>
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<!-- END: issue_info -->
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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" />
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{LANG_MMYY}
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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> </td>
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<td colspan="3">
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<input type="text" name="city" value="{VAL_CITY}" class="textbox" /> </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> </td>
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<td colspan="3">
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<input type="text" name="state" value="{VAL_COUNTY}" size="2" class="textbox" /> </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> </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" /> </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> </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 --> |