@extends('header') @section('content') {{ Former::open('payment/' . $invitationKey)->rules(array( 'first_name' => 'required', 'last_name' => 'required', 'card_number' => 'required', 'expiration_month' => 'required', 'expiration_year' => 'required', 'cvv' => 'required', 'address1' => 'required', 'city' => 'required', 'state' => 'required', 'postal_code' => 'required' )) }} {{ Former::populate($client) }} {{ Former::populateField('first_name', $contact->first_name) }} {{ Former::populateField('last_name', $contact->last_name) }}
{{ Former::legend('Secure Payment') }} {{ Former::text('first_name') }} {{ Former::text('last_name') }}

 

{{ Former::text('card_number') }} {{ Former::select('expiration_month')->addOption('','') ->addOption('01 - January', '1') ->addOption('02 - February', '2') ->addOption('03 - March', '3') ->addOption('04 - April', '4') ->addOption('05 - May', '5') ->addOption('06 - June', '6') ->addOption('07 - July', '7') ->addOption('08 - August', '8') ->addOption('09 - September', '9') ->addOption('10 - October', '10') ->addOption('11 - November', '11') ->addOption('12 - December', '12') }} {{ Former::select('expiration_year')->addOption('','') ->addOption('2014', '2014') ->addOption('2015', '2015') ->addOption('2016', '2016') ->addOption('2017', '2017') ->addOption('2018', '2018') ->addOption('2019', '2019') ->addOption('2020', '2020') }} {{ Former::text('cvv')->label('CVV') }}

 

{{ Former::text('address1')->label('Street') }} {{ Former::text('address2')->label('Apt/Suite') }} {{ Former::text('city') }} {{ Former::text('state')->label('State/Province') }} {{ Former::text('postal_code') }} {{ Former::actions( Button::primary_submit_lg('Pay Now - ' . Utils::formatMoney($invoice->amount, $client->currency_id) )) }}

{{ Former::close() }} @stop