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52 lines
2.1 KiB
HTML
Executable File
52 lines
2.1 KiB
HTML
Executable File
<p align="center"><?php if (! empty($this->errormsg)) {formerr($this->errormsg);} ?></p>
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<div align="center">
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<p><?php print_string("paymentrequired") ?></p>
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<p><b><?php echo get_string("cost").": $CFG->enrol_currency $cost"; ?></b></p>
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<p><?php print_string("paymentinstant") ?></p>
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<form name="form" method="post" action="enrol.php" autocomplete="off">
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<input type="hidden" name="id" value="<?php p($course->id) ?>" />
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<table align="center" width="100%" border=0>
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<tr>
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<td align="right"><?php print_string("nameoncard", "enrol_authorize") ?>: </td>
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<td align="left"><input type="text" name="ccfirstname" size="16" value="<?php p($userfirstname) ?>" />
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<input type="text" name="cclastname" size="16" value="<?php p($userlastname) ?>" /></td>
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</tr>
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<tr>
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<td align="right"><?php print_string("ccno", "enrol_authorize") ?>: </td>
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<td align="left"><input type="text" name="cc" size="16" value="<?php p($form->cc) ?>" /></td>
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</tr>
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<tr>
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<td align="right"><?php print_string("ccexpire", "enrol_authorize") ?>: </td>
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<td align="left"><?php
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for ($i=1; $i<=12; $i++) {
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$months[$i] = userdate(gmmktime(12,0,0,$i,1,2000), "%B");
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}
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choose_from_menu($months, 'ccexpiremm', $form->ccexpiremm, '');
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?> <input type="text" name="ccexpireyyyy" size="4" maxlength="4" value="<?php p($form->ccexpireyyyy) ?>" /></td>
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</tr>
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<tr>
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<td align="right"><?php print_string("cctype", "enrol_authorize") ?>: </td>
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<td align="left"><?php
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choose_from_menu($CCTYPES, 'cctype', $form->cctype);
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?>
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</td>
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</tr>
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<tr>
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<td align="right"><?php print_string("ccvv", "enrol_authorize") ?>: </td>
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<td align="left"><input type="text" name="cvv" size="4" maxlength="4" value="<?php p($form->cvv) ?>" />
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<font size=1><?php print_string("ccvvhelp", "enrol_authorize") ?></font></td>
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</tr>
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<tr>
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<td align="right"><?php print_string("zipcode", "enrol_authorize") ?>: </td>
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<td align="left"><input type="text" name="cczip" size="5" value="<?php p($form->cczip) ?>" /></td>
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</tr>
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</table>
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<input type="submit" value="<?php print_string("sendpaymentbutton", "enrol_authorize") ?>">
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</form>
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</div>
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