{assign var=title value="Payment Confirmation"}
{include file="header.html"}
<h3 align=center>{$title}</h3>
<hr>
<center>

<form method=post action="https://merchant.ematters.com.au/cmaonline.nsf/ePayForm?OpenForm&Seq=1">
{foreach from=$vars key=k item=v}
<input type=hidden name={$k} value="{$v|escape}">
{/foreach}

<table class=vedit>
<tr>
    <th>Credit Card Type</th>
    <td><select name=CreditCardType>
        <option value="&lt;select card&gt;">&lt;select card&gt;</option>
        <option value="Visa">Visa</option>
        <option value="Mastercard">Mastercard</option>
        <option value="Bankcard">Bankcard</option>

        <option value="Diners">Diners</option>
        <option value="AMEX">AMEX</option>
        <option value="JCB">JCB</option>    
    </select></td>
</tr>
<tr>
    <th>Credit Card Number</th>
    <td><input name=CreditCardNumber></td>
</tr>
<tr>
    <th>Credit Card Expiry</th>
    <td>{html_select_date display_days=false prefix=CreditCardExpiry}</td>
</tr>
<tr>
    <th>Credit Card Holder Name</th>
    <td><input name=CreditCardHolderName value="{$member.name_f} {$member.name_l}"></td>
</tr>

</table>

<input type=submit value="Go to secure site">
</form>
<small>This form will be submitted to secure server.</small>
</center>
{include file="footer.html"}