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<?php 
	$number_racer = isset($number_racer)?$number_racer:"0";
	$total_amount = isset($total_amount)?$total_amount:"0";
	$racerArr = isset($racerArr)?$racerArr:array();
	//https://github.com/angelleye/paypal-codeigniter
?>

<div class="modal-content">
      <div class="modal-header">
        <button type="button" class="close" data-dismiss="modal">&times;</button>
        <h4 class="modal-title">Refund & Cancellation Policy</h4>
      </div>
      <div class="modal-body">
        <p> I hereby recognize and accept that all entry fees,
			product purchases and donations serviced via <b>Vermont
			Corporate Cup Challenge & State Agency Race / Vermont
			Governor's Council on Physical Fitness &
			Sports</b> are final, and <b>NOT REFUNDABLE UNDER ANY CIRCUMSTANCE.</b>
			If <b>Vermont Corporate Cup Challenge & State Agency Race / Vermont 
			Governor's Council on Physical Fitness & Sports</b> patron 
			the event organizer(s) agree to a refund based on 
			the patron's own individual refund policy, 
			I recognize and accept that <b>Vermont
			Corporate Cup Challenge & State Agency Race / Vermont 
			Governor's Council on Physical Fitness & Sports</b> 
			has the right to retain all transaction and processing fees 
			associated with my registration process.</p>
      </div>
      <div class="modal-footer">
        <button type="button" class="btn btn-default" data-dismiss="modal">Close</button>
      </div>
    </div>

</div>
</div>

<section class="pad-t100">
            <div class="container">
                <div class="row">
                    <div class="col-md-6">
                        <div class="section-title left" style="margin-bottom: 50px;">
                            <h3>Make a payment</h3>
                        </div>
                        <a data-toggle="modal" data-target="#policy" style="color: #222; letter-spacing: 1.5px; text-transform: uppercase;">Refund & Cancellation Policy</a>
                    </div>
                    <div class="col-md-6">
                        <blockquote class="primary mbl-mar-top">
                            <ul class="fa-ul">
							  <li><i class="fa-li fa fa-check-square"></i>Payment for <b style="color: red;"> <?php echo $number_racer;?> </b> member(s)  </li>
							  <li><i class="fa-li fa fa-check-square"></i>Total Payment: <b style="color: red;">$<?php echo $total_amount;?> </b> </li>
							  <li><i class="fa-li fa fa-check-square"></i>Note: No refunds will be provided for this race.  </li>
							  <li>
							  	 <i class="fa-li fa fa-check-square"></i> 
							  	 <img src="<?php echo base_url();?>assets_vcc/images/credit_card/mastercard.png" >
 								 <img src="<?php echo base_url();?>assets_vcc/images/credit_card/visa.png" >
 								 <img src="<?php echo base_url();?>assets_vcc/images/credit_card/discover.png" >
 								 <img src="<?php echo base_url();?>assets_vcc/images/credit_card/amex.png" > </li>
							</ul>
                        </blockquote>
                    </div>
                </div>
             </div>
        </section>
                
        <section class="pad-b70">
            <div class="container">  
                <div class="row" style="margin-top: 50px;">
                    <div class="col-md-12">
                        <div class="feature-3">
                            <form id="contactForm" action="<?php echo base_url()."home/Do_direct_payment"?>" class="contact-form" method="post" role="form">
		                            <input type="hidden" name="total_amount" value="<?php echo $total_amount;?>">
		                            <?php 
			                            foreach($racerArr as $r)
			                            {
			                            	echo '<input type="hidden" name="racerArr[]" value="'. $r. '">';
			                            }
		                            ?>
                                    <div class="row">
                							<div class="col-md-6">
                        						<div class="messages" style="padding-bottom: 10px; text-align: center;"><h4>Payment Information</h4></div>
                       								 <div class="controls">
                            							<div class="row">
							                                <div class="col-md-12">
							                                    <div class="form-group">
														      		<label class="control-label" for="card_type"><?php _e("Card Type"); ?></label>
													      			<select name="card_type" id="card_type"  class="form-control"> 
																		<option value="Visa">Visa</option>
																		<option value="MasterCard">Mastercard</option>
																		<option value="Discover">Discover</option>
																		<option value="Amex">American Express</option>
																	</select>		      	
														     	</div>
														     	<div class="form-group">
							                                    	<label class="control-label" for="card_number"><?php _e("Card Number"); ?></label>
							                                        <input id="card_number" type="text" maxlength="16"  name="card_number" class="form-control" placeholder="Card Number *" required="required" data-error="Please enter only digits.">
							                                        <div id="employer_zip_err" class="help-block with-errors"></div>
							                                    </div>
							                                    <div class="form-group">
														      		<label class="control-label" for="expiration_year"><?php _e("Expiration Year"); ?></label>
													      			<select name="expiration_year" id="expiration_year"  class="form-control"> 
																		<option value="2017">2017</option>
																		<option value="2018">2018</option>
																		<option value="2019">2019</option>
																		<option value="2020">2020</option>
																		<option value="2021">2021</option>
																		<option value="2022">2022</option>
																		<option value="2023">2023</option>
																		<option value="2024">2024</option>
																		<option value="2025">2025</option>
																		<option value="2026">2026</option>
																		<option value="2027">2027</option>
																		<option value="2028">2028</option>
																	</select>		      	
														     	</div>	
							                                    <div class="form-group">
														      		<label class="control-label" for="expiration_month"><?php _e("Expiration Month"); ?></label>
													      			<select name="expiration_month" id="expiration_month"  class="form-control"> 
																		<option value="01">January</option>
																		<option value="02" selected="selected">February</option>
																		<option value="03">March</option>
																		<option value="04">April</option>
																		<option value="05">May</option>
																		<option value="06">June</option>
																		<option value="07">July</option>
																		<option value="08">August</option>
																		<option value="09">September</option>
																		<option value="10">October</option>
																		<option value="11">November</option>
																		<option value="12">December</option>
																	</select>		      	
														     	</div>	
														     	<div class="form-group">
							                                    	<label class="control-label" for="cvv"><?php _e("Card Verification # (CVV/CID)"); ?></label>
							                                        <input id="cvv" type="text" maxlength="16"  name="cvv" class="form-control" placeholder="Card Verification # (CVV/CID) *" required="required" data-error="Please enter only digits.">
							                                        <div id="employer_zip_err" class="help-block with-errors"></div>
							                                    </div>													     							                                    
							                                </div>
                           								</div>
                       							    </div>
               							 </div>
                						<div class="col-md-6">
                        						<div class="messages" style="padding-bottom: 10px; text-align: center;"><h4>Billing Information</h4></div>
                       								 <div class="controls">
                            							<div class="row">
							                                <div class="col-md-6">
							                                    <div class="form-group">
							                                    	<label class="control-label" for="first_name"><?php _e("First Name"); ?></label>
							                                        <input id="first_name" type="text" maxlength="100" name="first_name" class="form-control" placeholder="First Name *" required="required" data-error="First Name is required.">
							                                        <div class="help-block with-errors"></div>
							                                    </div>
							                                </div>
							                                <div class="col-md-6">
							                                    <div class="form-group">
							                                    	<label class="control-label" for="last_name"><?php _e("Last Name"); ?></label>
							                                        <input id="last_name" type="text" maxlength="100" name="last_name" class="form-control" placeholder="Last Name *" required="required" data-error="Last Name is required.">
							                                        <div class="help-block with-errors"></div>
							                                    </div>
							                                </div>
							                              </div>
							                              
							                              <div class="row">
							                                <div class="col-md-12">
							                                    <div class="form-group">
							                                    	<label class="control-label" for="address_1"><?php _e("Address 1"); ?></label>
							                                        <input id="address_1" type="text" maxlength="200" name="address_1" class="form-control" placeholder="Address 1 *" required="required" data-error="Address 1 is required.">
							                                        <div class="help-block with-errors"></div>
							                                    </div>
							                                   </div> </div>
							                                 
							                                    <div class="row">
							                                <div class="col-md-12">
							                                    <div class="form-group">
							                                    	<label class="control-label" for="address_2"><?php _e("Address 2"); ?></label>
							                                        <input id="address_2" type="text" maxlength="200" name="address_2" class="form-control" placeholder="Address 2 *" required="required" data-error="Address 2 is required.">
							                                        <div class="help-block with-errors"></div>
							                                    </div>
							                                  </div>  </div>
							                                  
							                                  <div class="row">
							                                   <div class="col-md-6"> 
							                                    <div class="form-group">
							                                    	<label class="control-label" for="city"><?php _e("City"); ?></label>
							                                        <input id="city" type="text" maxlength="200" name="city" class="form-control" placeholder="City *" required="required" data-error="City is required.">
							                                        <div class="help-block with-errors"></div>
							                                    </div></div> <div class="col-md-6"> 
							                                    <div class="form-group">
														      		<label class="control-label" for="state"> <?php _e("State"); ?></label>
													      			<select name="state" id="state"  class="form-control"> 
																		<option value="AL">Alabama</option>
																		<option value="AK">Alaska</option>
																		<option value="AZ">Arizona</option>
																		<option value="AR">Arkansas</option>
																		<option value="CA">California</option>
																		<option value="CO">Colorado</option>
																		<option value="CT">Connecticut</option>
																		<option value="DE">Delaware</option>
																		<option value="DC">District Of Columbia</option>
																		<option value="FL">Florida</option>
																		<option value="GA">Georgia</option>
																		<option value="HI">Hawaii</option>
																		<option value="ID">Idaho</option>
																		<option value="IL">Illinois</option>
																		<option value="IN">Indiana</option>
																		<option value="IA">Iowa</option>
																		<option value="KS">Kansas</option>
																		<option value="KY">Kentucky</option>
																		<option value="LA">Louisiana</option>
																		<option value="ME">Maine</option>
																		<option value="MD">Maryland</option>
																		<option value="MA">Massachusetts</option>
																		<option value="MI">Michigan</option>
																		<option value="MN">Minnesota</option>
																		<option value="MS">Mississippi</option>
																		<option value="MO">Missouri</option>
																		<option value="MT">Montana</option>
																		<option value="NE">Nebraska</option>
																		<option value="NV">Nevada</option>
																		<option value="NH">New Hampshire</option>
																		<option value="NJ">New Jersey</option>
																		<option value="NM">New Mexico</option>
																		<option value="NY">New York</option>
																		<option value="NC">North Carolina</option>
																		<option value="ND">North Dakota</option>
																		<option value="OH">Ohio</option>
																		<option value="OK">Oklahoma</option>
																		<option value="OR">Oregon</option>
																		<option value="PA">Pennsylvania</option>
																		<option value="RI">Rhode Island</option>
																		<option value="SC">South Carolina</option>
																		<option value="SD">South Dakota</option>
																		<option value="TN">Tennessee</option>
																		<option value="TX">Texas</option>
																		<option value="UT">Utah</option>
																		<option value="VT">Vermont</option>
																		<option value="VA">Virginia</option>
																		<option value="WA">Washington</option>
																		<option value="WV">West Virginia</option>
																		<option value="WI">Wisconsin</option>
																		<option value="WY">Wyoming</option>
																	</select>		      	
														     	</div>
														     	</div></div>
														     	
														     	<div class="row">
							                                   <div class="col-md-6"> 
														     	<div class="form-group">
							                                    	<label class="control-label" for="zip"><?php _e("ZIP/Postal Code"); ?></label>
							                                        <input id="zip" pattern="[0-9]{5}" maxlength="5" name="zip" class="form-control" placeholder="ZIP/Postal Code * *" required="required" data-error="Please enter only digits with 5 characters">
							                                        <div id="employer_zip_err" class="help-block with-errors"></div>
							                                    </div>
							                                    </div>
							                                    <div class="col-md-6"> 
							                                    <div class="form-group">
							                                    	<label class="control-label" for="form_email"><?php _e("Email"); ?></label>
							                                        <input id="form_email" type="email" autocomplete="off" name="form_email" class="form-control" placeholder="Email *" required="required" data-error="Valid email is required.">
							                                        <div class="help-block with-errors"></div>
							                                    </div>
							                                    </div>
							                                </div>
                           								</div>

</div>   
                       					</div>
			                            <div class="row">
				                            
			                                <div class="col-md-12" style="text-align: center;">
			                                	<input type="submit" id="submit_btn" class="btn btn-primary" value="Submit">
			                                </div>
			                            </div>                       					
                   					</form>
               					</div>
                        </div>
                    </div>
                </div>
        
        </section>

<section class="pad-t100">&nbsp</section>
        
<script>
	$(document).ready(function(){
		$('#contactForm').validator();
	});

$('#contactForm').submit(function() {
		$body = $("body");
    	$body.addClass("loading");
    	return true;
	});

</script>