File "payment_form.php"
Full Path: /home/ichhrkpd/public_html/template/views/paypal/payment_form.php
File size: 17.72 KB
MIME-type: text/x-php
Charset: utf-8
<?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 id="policy" class="modal fade" role="dialog">
<div class="modal-dialog">
<!-- Modal content-->
<div class="modal-content">
<div class="modal-header">
<button type="button" class="close" data-dismiss="modal">×</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>
<!-- Start Service Section -->
<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"> </section>
<script>
$(document).ready(function(){
$('#contactForm').validator();
});
$('#contactForm').submit(function() {
$body = $("body");
$body.addClass("loading");
return true;
});
</script>