<%= text_field_tag "#{param_prefix}[account_holder_name]", "#{@order.bill_address_firstname} #{@order.bill_address_lastname}", { id: "account_holder_name", class: 'spree-flat-input', placeholder: Spree.t('stripe.ach.account_holder_name')} %>

<%= select_tag "#{param_prefix}[account_holder_type]", options_for_select(%w(Individual Company)), {id: "account_holder_type", class: 'spree-flat-input', placeholder: Spree.t('stripe.ach.account_holder_type')} %>

<%= text_field_tag "#{param_prefix}[routing_number]", '', {id: 'routing_number', class: 'spree-flat-input', autocomplete: "off", placeholder: Spree.t('stripe.ach.routing_number'), maxlength: 9} %>

<%= text_field_tag "#{param_prefix}[account_number]", '', {id: 'account_number', class: 'spree-flat-input', autocomplete: "off", placeholder: Spree.t('stripe.ach.account_number')} %>

<%= text_field_tag "#{param_prefix}[verify_account_number]", '', {id: 'verify_account_number', class: 'spree-flat-input', autocomplete: "off", placeholder: Spree.t('stripe.ach.verify_account_number')} %>