<% param_prefix = "payment_source[#{payment_method.id}]" %>
<%= label_tag "account_holder_name#{payment_method.id}", raw(Spree.t('stripe.ach.account_holder_name') + required_span_tag) %> <%= text_field_tag "#{param_prefix}[account_holder_name]", '', class: 'required form-control', id: "account_holder_name#{payment_method.id}" %>
<%= label_tag "account_holder_type#{payment_method.id}", raw(Spree.t('stripe.ach.account_holder_type') + required_span_tag) %> <%= select_tag "#{param_prefix}[account_holder_type]", options_for_select(%w(Individual Company)), {id: "account_holder_type#{payment_method.id}", class: 'required form-control'} %>
<%= label_tag "routing_number#{payment_method.id}", raw(Spree.t('stripe.ach.routing_number') + required_span_tag)%> <%= text_field_tag "#{param_prefix}[routing_number]", '', class: 'required form-control', id: "routing_number#{payment_method.id}", maxlength: 9 %>
<%= label_tag "account_number#{payment_method.id}", raw(Spree.t('stripe.ach.account_number') + required_span_tag) %> <%= text_field_tag "#{param_prefix}[account_number]", '', class: 'required form-control', id: "account_number#{payment_method.id}" %>
<%= label_tag "verify_account_number#{payment_method.id}", raw(Spree.t('stripe.ach.verify_account_number') + required_span_tag) %> <%= text_field_tag "#{param_prefix}[verify_account_number]", '', class: 'required form-control', id: "verify_account_number#{payment_method.id}" %>