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<p align="center"><?php if (!empty($this->ccerrormsg)) { formerr($this->ccerrormsg); } ?></p>
<div align="center">
<p><?php print_string("paymentrequired") ?></p>
<p><b><?php echo get_string("cost").": $curcost[currency] $curcost[cost]"; ?></b></p>
<p><?php print_string("paymentinstant") ?></p>
<form name="form" method="post" action="enrol.php" autocomplete="off">
<input type="hidden" name="id" value="<?php p($course->id) ?>" />
<table align="center" width="100%" border=0>
<td align="right"><?php print_string("nameoncard", "enrol_authorize") ?>: </td>
<td align="left"><input type="text" name="ccfirstname" size="15" value="<?php p($userfirstname) ?>" />
<input type="text" name="cclastname" size="15" value="<?php p($userlastname) ?>" /></td>
<td align="right"><?php print_string("ccno", "enrol_authorize") ?>: </td>
<td align="left"><input type="text" name="cc" size="16" value="<?php p($form->cc) ?>" /></td>
<td align="right"><?php print_string("ccexpire", "enrol_authorize") ?>: </td>
<td align="left"><?php
for ($i=1; $i<=12; $i++) {
$months[$i] = userdate(gmmktime(12,0,0,$i,1,2000), "%B");
choose_from_menu($months, 'ccexpiremm', $form->ccexpiremm);
$nowdate = getdate();
$nowyear = $nowdate["year"]-1;
for ($i=$nowyear; $i<=$nowyear+11; $i++) {
$years[$i] = $i;
choose_from_menu($years, 'ccexpireyyyy', $form->ccexpireyyyy);
<td align="right"><?php print_string("cctype", "enrol_authorize") ?>: </td>
<td align="left"><?php
$CCTYPES = array(
'mcd' => 'Master Card', 'vis' => 'Visa', 'amx' => 'American Express',
'dsc' => 'Discover', 'dnc' => 'Diners Club', 'jcb' => 'JCB',
'swi' => 'Switch', 'dlt' => 'Delta', 'enr' => 'EnRoute'
choose_from_menu($CCTYPES, 'cctype', $form->cctype);
<td align="right"><?php print_string("ccvv", "enrol_authorize") ?>: </td>
<td align="left"><input type="text" name="cvv" size="4" maxlength="4" value="<?php p($form->cvv) ?>" />
<font size=1><?php print_string("ccvvhelp", "enrol_authorize") ?></font></td>
<td align="right"><?php print_string("zipcode", "enrol_authorize") ?>: </td>
<td align="left"><input type="text" name="cczip" size="5" value="<?php p($form->cczip) ?>" /></td>
<input type="submit" value="<?php print_string("sendpaymentbutton", "enrol_authorize") ?>">
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