{assign var=title value="MultiCards 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://secure.multicards.com/cgi-bin/order2/processorder1.pl">
{* multi-cards internal parameters *}
<input type=hidden name=deferred_entry value=1>
<input type=hidden name=mer_id value={$this_config.mer_id}>
<input type=hidden name=num_items value=1>
<input type=hidden name=mer_url_idx value={$this_config.page_id}>
<input type=hidden name=item1_desc value="{$product.title|escape}">
<input type=hidden name=item1_price value="{$product.price}">
<input type=hidden name=item1_qty value="1">
<input type=hidden name=user1 value={$payment.payment_id}>
<input type=hidden name=user2 value={$payment.member_id}>
{* /end of multi-card parameters *}

<table align=center class=vedit>
<tr>
    <th width=40%><b>Contact Name</b><br>
    <small>for contact</small></th>
    <td nowrap><input type=text name=cust_name value="{$smarty.request.name_f|escape} {$smarty.request.name_l|escape}" size=30>
    </td>
</tr>
<tr>
    <th width=40%><b>Contact EMail</b><br>
    <small>for contact</small></th>
    <td nowrap><input type=text name=cust_email value="{$smarty.request.email|escape}" size=30>
    </td>
</tr>
<tr>
    <th width=40%><b>Card Name</b><br>
    <small><b>exactly</b> as on credit card</small></th>
    <td nowrap><input type=text name=card_name value="{$smarty.request.name_f|escape} {$smarty.request.name_l|escape}" size=30>
    </td>
</tr>
<tr>
    <th width=40%><b>Address</b><br>
    <small><b>exact</b> address of credit card</small></th>
    <td nowrap><input type=text name=cust_address1 value="{$smarty.request.street|escape}" size=30>
    </td>
</tr>
<tr>
    <th width=40%><b>City</b><br>
    <small><b>exact</b> city + Post code (excl USA) of credit card<br>
    holder, ie. <i>London E12 6HB</i>
    </small></th>
    <td nowrap><input type=text name=cust_city value="{$smarty.request.city|escape}" size=30>
    </td>
</tr>
<tr>
    <th width=40%><b>Country</b><br>
    <small><b>exact</b> country of credit card holder
    </small></th>
    <td nowrap><input type=text name=cust_country value="{$smarty.request.country|escape}" size=30>
    </td>
</tr>
<tr>
    <th width=40%><b>State</b><br>
    <small><b>exact</b> state of credit card holder
    </small></th>
    <td nowrap><input type=text name=cust_state value="{$smarty.request.state|escape}" size=30>
    </td>
</tr>
<tr>
    <th width=40%><b>ZIP</b><br>
    <small><b>exact</b> ZIP of USA credit <br>
    of card holder <br>
    (if not in USA, enter <i>99999</i>)
    </small></th>
    <td nowrap><input type=text name=cust_zip value="{$smarty.request.zip|escape}" size=30>
    </td>
</tr>
</table>
<input type=submit value="Proceed">

</form>
</center>
{include file=$footer}