Open-ILS/src/templates-bootstrap/opac/myopac/generic_payment_form.tt2

   1     <form method="post" id="payment_form" action='#payment'>
   2         <input type="hidden" name="last_chance" value="1" />
   3         [% FOR xact IN CGI.param('xact') %]
   4         <input type="hidden" name="xact" value="[% xact | html %]" />
   5         [% END %]
   6         [% FOR xact IN CGI.param('xact_misc') %]
   7         <input type="hidden" name="xact_misc" value="[% xact | html %]" />
   8         [% END %]
   9         [% IF ctx.use_stripe %]
  10         <input type="hidden" name="stripe_token" id="stripe_token" />
  11         [% END %]
  12
  13          <table id="billing_info_table" class="table table-hover">
  14          <thead>
  15           <th colspan='2'><strong>[% l('Billing Information') %]</strong></th>
  16          </thead>
  17           <tbody>
  18
  19                <tr>
  20                 <td><label for="payment-first-name">[% l('First Name') %]</label></td>
  21                     <td><input name="given-name" type="text"  name="billing_first" id="payment-first-name"
  22                         value="[% ctx.user.first_given_name | html %]" class="form-control"/></td>
  23                 </tr>
  24                 <tr>
  25                     <td><label for="payment-last-name">[% l('Last Name') %]</label></td>
  26                     <td><input name="family-name" type="text" name="billing_last" id="payment-last-name"
  27                         value="[% ctx.user.family_name | html %]" class="form-control"/></td>
  28                 </tr>
  29
  30                 <tr>
  31                     <td><label for="payment-email-addr">[% l('Email Address') %]</label></td>
  32                     <td>
  33
  34                         <input id="payment-email-addr" type="text"
  35                              value="[% ctx.user.email | html %]" disabled="disabled"
  36                             readonly="readonly" class="form-control" name="email"/>
  37                         <a title="[% l('Update Email Address') %]"
  38                             href="[% ctx.opac_root %]/myopac/update_email?return_to_referer=1">[% l("Update") %]</a>
  39                     </td>
  40                 </tr>
  41                 <tr>
  42                     <td><label for="payment-billing-address">[% l('Street Address') %]</label></td>
  43                     <td><input type="text" name="billing_address" id="payment-billing-address"
  44                         value="[% ctx.user.billing_address.street1 _ ctx.user.billing_address.street2 | html %]" class="form-control"/></td>
  45                 </tr>
  46                 <tr>
  47                     <td><label for="payment-billing-city">[% l('City' )%]</label></td>
  48                     <td><input type="text" name="billing_city" id="payment-billing-city"
  49                         value="[% ctx.user.billing_address.city | html %]" class="form-control"/></td>
  50                 </tr>
  51                 <tr>
  52                     <td><label for="payment-billing-state">[% l('State or Province') %]</label></td>
  53                     <td><input type="text" name="billing_state" id="payment-billing-state"
  54                         value="[% ctx.user.billing_address.state | html %]" class="form-control" /></td>
  55                 </tr>
  56                 <tr>
  57                     <td><label for="paymenet-billing-zip">[% l('Postal Code') %]</label></td>
  58                     [% USE zip=String(ctx.user.billing_address.post_code) %]
  59                     <td><input type="tel" pattern="[/^[a-zA-Z0-9 _-]{7}$/]*" maxlength="7" size="7" name="billing_zip" id="paymenet-billing-zip"
  60                         value="[% zip.truncate(5)  %]" class="form-control"/></td>
  61                 </tr>
  62                </tbody>
  63                </table>
  64
  65                <table id="credit_card_info_table" class="table">
  66                <thead>
  67                    <th colspan='2'><strong>[% l('Credit Card Information') %]</strong></th>
  68                </thead>
  69                <tbody>
  70
  71                 <tr>
  72                     <td><label for="payment-credit-card">[% l('Credit Card #') %]</label></td>
  73
  74                      <!-- Make type tel, which prompts for numbers in mobile -->
  75                     <td><input class="form-control" type="tel" pattern="[0-9]*" maxlength="16" id="payment-credit-card" required name="number" /></td>
  76                 </tr>
  77                 <tr>
  78                     <td><label for="payment-security-code">[% l('Security Code') %]</label></td>
  79                     <td>
  80                          <!-- Make type tel, which prompts for numbers in mobile -->
  81                         <input class="form-control" type="tel" pattern="[0-9]*" size="4" maxlength="5" id="payment-security-code" name="cvv2" /></td>
  82                 </tr>
  83                 <tr>
  84                     <td><label for="payment-expire-month">[% l('Expiration Month') %]</label></td>
  85                     <td>
  86                         <select class="form-control" id="payment-expire-month" required
  87                         [% IF ctx.use_stripe %]
  88                         data-stripe="exp_month"
  89                         [% ELSE %]
  90                         name="expire_month"
  91                         [% END %]
  92                         >
  93                             <option value="-1"></option>
  94                             <option value="01">[% l("January (1)") %]</option>
  95                             <option value="02">[% l("February (2)") %]</option>
  96                             <option value="03">[% l("March (3)") %]</option>
  97                             <option value="04">[% l("April (4)") %]</option>
  98                             <option value="05">[% l("May (5)") %]</option>
  99                             <option value="06">[% l("June (6)") %]</option>
 100                             <option value="07">[% l("July (7)") %]</option>
 101                             <option value="08">[% l("August (8)") %]</option>
 102                             <option value="09">[% l("September (9)") %]</option>
 103                             <option value="10">[% l("October (10)") %]</option>
 104                             <option value="11">[% l("November (11)") %]</option>
 105                             <option value="12">[% l("December (12)") %]</option>
 106                         </select>
 107                     </td>
 108                 </tr>
 109                 <tr>
 110                     <td><label for="payment-expire-year">[% l('Expiration Year') %]</label></td>
 111                     <td>
 112                         <select class="form-control" id="payment-expire-year" name="expire_year" >
 113                         [% year = date.format(date.now, '%Y');
 114                         y = year;
 115                         WHILE y < year + 10; # show ten years starting now %]
 116                             <option value="[% y %]">[% y %]</option>
 117                         [% y = y + 1; END %]
 118                         </select>
 119                     </td>
 120                 </tr>
 121                 <tr>
 122                    <td colspan='2'>
 123                        <div id="payment_actions">
 124                           [% l('Total amount:') %]
 125                            <strong>[% money(ctx.fines.balance_owed) %]</strong><br />
 126
 127                          <button type="submit" id="payment_submit" class="btn btn-confirm"><i class="fas fa-arrow-circle-right"></i> [% l('Next') %]</button>
 128                          <a href="[% mkurl(ctx.opac_root _ '/myopac/main', {}, 1) %]" class="btn btn-deny"><i class="fas fa-ban"></i> [% l('Cancel') %]</a>
 129                          <br/>
 130                          </div>
 131                    </td>
 132                 </tr>
 133
 134           </tbody>
 135         </table>
 136          [% INCLUDE "opac/parts/myopac/main_refund_policy.tt2" %]
 137     </form>
 138