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[%# The contents of this file are subject to the Mozilla Public
# License Version 1.1 (the "License"); you may not use this file
# except in compliance with the License. You may obtain a copy of
# the License at http://www.mozilla.org/MPL/
#
# Software distributed under the License is distributed on an "AS
# IS" basis, WITHOUT WARRANTY OF ANY KIND, either express or
# implied. See the License for the specific language governing
# rights and limitations under the License.
#
# The Original Code is the REMO Extension
#
# The Initial Developer of the Original Code is the Mozilla Foundation
# Portions created by the Initial Developers are Copyright (C) 2011 the
# Initial Developer. All Rights Reserved.
#
# Contributor(s):
# Dave Lawrence <dkl@mozilla.com>
#%]
[% PROCESS global/variables.none.tmpl %]
[% PROCESS global/header.html.tmpl
title = "Mozilla Reps Payment Form"
generate_api_token = 1
style_urls = [ 'extensions/REMO/web/styles/moz_reps.css' ]
javascript_urls = [ 'extensions/REMO/web/js/form_validate.js',
'extensions/REMO/web/js/payment.js',
'js/util.js',
'js/field.js' ]
%]
<script [% script_nonce FILTER none %]></script>
<h1>Mozilla Reps - Payment Form</h1>
<form method="post" action="page.cgi" id="paymentForm" enctype="multipart/form-data"
onSubmit="return validateAndSubmit();">
<input type="hidden" id="id" name="id" value="remo-form-payment.html">
<input type="hidden" id="token" name="token" value="[% token FILTER html %]">
<input type="hidden" id="action" name="action" value="commit">
<table id="reps-form">
<tr class="odd">
<td width="25%"><strong>First Name: <span style="color: red;">*</span></strong></td>
<td>
<input type="text" name="firstname" id="firstname" value="" size="40" placeholder="John">
</td>
</tr>
<tr class="even">
<td><strong>Last Name: <span style="color: red;">*</span></strong></td>
<td>
<input type="text" name="lastname" id="lastname" value="" size="40" placeholder="Doe">
</td>
</tr>
<tr class="odd">
<td><strong>Wiki user profile:<span style="color: red;">*</span></strong></td>
<td>
<input type="text" name="wikiprofile" id="wikiprofile" value="" size="40" placeholder="JohnDoe">
</td>
</tr>
<tr class="even">
<td><strong>Event wiki page: <span style="color: red;">*</span></strong></td>
<td>
<input type="text" name="wikipage" id="wikipage" value="" size="40">
</td>
</tr>
<tr class="odd">
<td><strong>Budget request [% terms.bug %]: <span style="color: red;">*</span></strong></td>
<td>
<input type="text" name="bug_id" id="bug_id" value="" size="40">
</td>
</tr>
<tr class="odd">
<td colspan="2">
<div id="bug_info" style="display:none;"></div>
</td>
</tr>
<tr class="even">
<td colspan="2">
<strong>Have you already received payment for this event?</strong>
<input type="checkbox" name="receivedpayment" id="receivedpayment" value="1" checked="true">
<div id="paymentinfo" style="display:none;">
Please send an email to William at mozilla.com with all the information below:<br>
<br>
Payment information:<br>
Bank name:<br>
Bank address: <br>
IBAN:<br>
Swift code/BIC:<br>
Additional bank details (if necessary):
</div>
</td>
</tr>
<tr class="odd">
<td colspan="2">
<strong>Expense form and scanned receipts/invoices:</strong>
</td>
</tr>
<tr class="odd">
<td>Expense Form: <span style="color: red;">*</span></td>
<td><input type="file" id="expenseform" name="expenseform" size="40"></td>
</tr>
<tr class="odd">
<td valign="top">Receipts File: <span style="color: red;">*</span></td>
<td>
<input type="file" id="receipts" name="receipts" size="40"><br>
<font style="color:red;">
Please black out any bank account information included<br>
on receipts before attaching them.
</font>
</td>
</tr>
<tr class="even">
<td> </td>
<td align="right">
<input type="submit" id="commit" value="Submit Request">
</td>
</tr>
</table>
</form>
<p>
<strong><span style="color: red;">*</span></strong> - Required field<br>
Thanks for contacting us.
</p>
[% PROCESS global/footer.html.tmpl %]
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