{assign var=title value="Payment Confirmation"}

{include file="header.html"}

<h3 align=center>{$title}</h3>

<hr>

<center>



<form method=post 
{if $this_config.testing}
ACTION="https://www.gochargeit.com/cgi-bin/remotedemo.cgi"
{else}
ACTION="https://www.gochargeit.com/cgi-bin/remote.cgi"
{/if}
>

{foreach from=$vars key=k item=v}

<input type=hidden name={$k} value="{$v|escape}">

{/foreach}


    <center>
    <table BGCOLOR="BLACK" BORDER=0>
    <tr><td ALIGN="CENTER">
   <table BGCOLOR="BEIGE" width="100%" border=0 CELLPADDING=8 CELLSPACING=3>
   <tr><td colspan=2 align=center><b><font size=+1 COLOR="RED">Please provide the following credit card information.</font><br></b>
    </tr>
<tr>
<td align="right" valign="middle"><b><font FACE="ARIAL" SIZE="2">
  Name On Credit Card:</font></b></td><td align="left"><input SIZE=25 MAXLENGTH=50 NAME="f_ccname" VALUE="{$member.name_f} {$member.name_l}"></td></tr>
<td align="right" valign="middle"><b><font FACE="ARIAL" SIZE="2">
  CC Statement Address:</font></b></td><td align="left"><input SIZE=25 MAXLENGTH=50 NAME="f_ccaddr" VALUE="{$member.street}"></td></tr>
<td align="right" valign="middle"><b><font FACE="ARIAL" SIZE="2">
  Your City:</font></b></td><td align="left"><input type="text" NAME="f_cccity" SIZE=25 MAXLENGTH=50 VALUE={$member.city}></td></tr>
<td align="right" valign="middle"><b><font FACE="ARIAL" SIZE="2">
  State:</font></b></td><td align="left"><input type="text" NAME="f_ccstate" VALUE="{$member.state}" SIZE=4 MAXLENGTH=3>&nbsp;&nbsp;<font FACE="ARIAL" SIZE="2"><b>Zip:</b></font> <input type="text" NAME="f_cczip" value="{$member.zip}" SIZE=10 MAXLENGTH=10></td></tr>


<td align="right" valign="middle"><b><font FACE="ARIAL" SIZE="2">
  Card Type:</font></b></td><td align="left">
<input TYPE=radio NAME="f_cctype" Value="Visa Card"><font SIZE=2>Visa</font> 
<input TYPE=radio NAME="f_cctype" Value="Master Card"><font SIZE=2>Master Card</font>
</td></tr>

<td align="right" valign="middle"><b><font FACE="ARIAL" SIZE="2">
  Credit Card#:</font></b></td><td align="left"><input TYPE="text" NAME="card" SIZE=25></td></tr>

<td align="right" valign="middle"><b><font FACE="ARIAL" SIZE="2">
  Expiration Date (mmyy):</font></b></td><td align="left"><input TYPE="TEXT" SIZE="6" MAXLENGTH=4 NAME="expir"></td></tr>
</table>
</td></tr></table>


<input TYPE="hidden" NAME="returnurl" VALUE="http://www.gochargeit.com/fnp/raging/chargelink.htm?returning">
<input TYPE="hidden" NAME="remoteurl" VALUE="{$config.root_url}/plugins/payment/echd/ipn.php">
<input TYPE="hidden" NAME="totallyremote" VALUE ="1">
<input type="hidden" name="locationredirect" value="1">


<b><font COLOR="RED" SIZE="2">This is real time authorization... the bank processor is being contacted for authorization.<br>
This process may take 10-40 seconds depending on internet traffic.</font><br>
    <input TYPE="SUBMIT" NAME="process" VALUE="Process Credit Card"><br>
<font COLOR="RED">ONLY PRESS ONCE</font></b>


</form>

<small>This form will be submitted to secure server.</small>

</center>

{include file="footer.html"}