{assign var=title value="Credit Card Payment Page"}
{include file=$header}
<center>
<br>
<div class=hdr>{$title}</div>
<hr>

{if $error}
<table><tr><td>
{foreach from=$error item=e}
<li><font color=red><b>{$e}</b></font>
{/foreach}
</td></tr></table>
{/if}

<form name=signup method=post action="https://www.beanstream.com/scripts/process_transaction.asp">
{foreach from=$vars item=v key=k}
<input type=hidden name="{$k|escape}" value="{$v|escape}">
{/foreach} 

<table align=center class=vedit>
<tr>
    <th width=40%><b>Card Name</b><br>
    <small><b>exactly</b> as on credit card</small></th>
    <td nowrap><input type=text name=trnCardOwner value="{$smarty.request.trnCardOwner|default:$member.name}" size=30>
    </td>
</tr>
<!-- CREDIT CARD INFO -->
<tr>
    <th width=40%><b>Credit Card Number</b><br>
    </small></th>
    <td nowrap><input type=text name=trnCardNumber value="{$smarty.request.trnCardNumber|escape}" size=21>
    </td>
</tr>
<tr>
    <th width=40%><b>Credit Card Expiration</b><br>
    </small></th>
    <td nowrap>
      <select name="trnExpMonth">
<option value="01">January</option>
<option value="02">February</option>
<option value="03">March</option>
<option value="04">April</option>

<option value="05">May</option>
<option value="06">June</option>
<option value="07">July</option>
<option value="08">August</option>
<option value="09">September</option>
<option value="10">October</option>
<option value="11">November</option>
<option value="12">December</option>
</select>

<select name=trnExpYear size=1>
{php}
for ($y=substr(date('Y'), 2, 2);$y<substr(date('Y'), 2, 2)+10;$y++,$y=sprintf('%02d', $y))
    print "<option value=$y>20$y</option>\n";
{/php}
</select>

    </td>
</tr>
<tr>
</tr>
<tr>
    <th width=40%><b>Address</b><br>
    <small><b>exact</b> address of credit card</small></th>
    <td nowrap><input type=text name=ordAddress1 value="{$smarty.request.ordAddress1|default:$member.street}" size=30>
    </td>
</tr>
<tr>
    <th width=40%><b>City</b><br>
    <small><b>exact</b> city of credit card<br>
    holder</i>
    </small></th>
    <td nowrap><input type=text name=ordCity value="{$smarty.request.ordCity|default:$member.city}" size=30>
    </td>
</tr>
<tr>
    <th width=40%><b>Country</b><br>
    <small><b>exact</b> country of credit card holder
    </small></th>
    <td nowrap><select name=ordCountry size=1>
    {html_options selected=$member.country options=$config.country_options}
    </select>
    </td>
</tr>
<tr>
    <th width=40%><b>State</b><br>
    <small><b>exact</b> state of credit card holder
    </small></th>
    <td nowrap>
    <select name=ordProvince size=1>
    {html_options selected=$member.state options=$config.state_options}
    </select>

    </td>
</tr>
<tr>
    <th width=40%><b>ZIP</b><br>
    </small></th>
    <td nowrap><input type=text name=ordPostalCode value="{$smarty.request.ordPostalCode|default:$member.zip}" size=30>
    </td>
</tr>
<tr>
    <th width=40%><b>Phone</b><br>
    </small></th>
    <td nowrap><input type=text name=ordPhoneNumber value="{$smarty.request.ordPhoneNumber|default:$member.data.phone}" size=30>
    </td>
</tr>
</table>
<input type=submit value="Proceed">

<i>this form will be submitted to secure server</i>
</form>
</center>
{include file=$footer}