source: main/kofacustom.nigeria/trunk/src/kofacustom/nigeria/remita/browser_templates/goto_remita.pt

<form i18n:domain="kofacustom.nigeria"
  tal:attributes="action view/action" method="POST">

  <p i18n:translate="">
    Your payment details were sent to Remita and a retrieval reference
    number (RRR) has been generated. Please click the button below to make
    your RRR payment.
  </p>

  <table class="form-table" i18n:domain="waeup.kofa">
    <tbody>
      <tr>
        <td i18n:translate="" class="fieldname">
          Total Amount Authorized:</td>
        <td>
          <span tal:replace="view/context/amount_auth">AMOUNT</span>
        </td>
      </tr>
      <tr>
        <td i18n:translate="" class="fieldname">
          Order Id:</td>
        <td>
          <span tal:replace="view/context/p_id">ORDERID</span>
        </td>
      </tr>
      <tr>
        <td i18n:translate="" class="fieldname">
          Remita Retrieval Reference:</td>
        <td>
          <span tal:replace="view/rrr">RRR</span>
        </td>
      </tr>
      <tr>
        <td i18n:translate="" class="fieldname">
          Remita Service Type Id:</td>
        <td>
          <span tal:replace="view/serviceTypeId">SERVCICETYPEID</span>
        </td>
      </tr>
      <tr>
        <td i18n:translate="" class="fieldname">
          Customer Name:</td>
        <td>
          <span tal:replace="view/customer/display_fullname">CUSTNAME</span>
        </td>
      </tr>
      <tr>
        <td i18n:translate="" class="fieldname">
          Email Address:</td>
        <td>
          <span tal:replace="view/customer/email">EMAIL</span>
        </td>
      </tr>
    </tbody>
  </table>

  <input name="merchantId" tal:attributes="value view/merchantId" type="hidden">
  <input name="hash" tal:attributes="value view/hashvalue" type="hidden">
  <input name="rrr" tal:attributes="value view/rrr" type="hidden">
  <input name="responseurl" tal:attributes="value view/responseurl" type="hidden">

  <br />

  <p i18n:translate="">
    Please note that Remita is adding a service charge which will not be shown
    on the payment slip after payment.
  </p>

  <br />

  <input type="submit" class="btn btn-primary" tal:attributes="value view/submit_button"/>

  <br /><br />

  <img src="/static/img/remita-payment-logo-horizonal.png" />

</form>