@extends('public.header') @section('content') {{ Former::vertical_open($url)->rules(array( 'first_name' => 'required', 'last_name' => 'required', 'card_number' => 'required', 'expiration_month' => 'required', 'expiration_year' => 'required', 'cvv' => 'required', 'address1' => 'required', 'city' => 'required', 'state' => 'required', 'postal_code' => 'required', 'country' => 'required', 'phone' => 'required', 'email' => 'required|email' )) }} @if ($client) {{ Former::populate($client) }} {{ Former::populateField('first_name', $contact->first_name) }} {{ Former::populateField('last_name', $contact->last_name) }} @endif

Secure Payment

256-BiT Encryption

@if (isset($paymentTitle))

{{ $paymentTitle }}
@if (isset($paymentSubtitle)) {{ $paymentSubtitle }} @endif

 

@endif

@if (isset($paymentTitle))
{{ Former::text('first_name') }}
{{ Former::text('last_name') }}
{{ Former::text('email') }}
@else
{{ Former::text('first_name') }}
{{ Former::text('last_name') }}
@endif
{{ Former::text('address1')->label('Street') }}
{{ Former::text('address2')->label('Apt/Suite') }}
{{ Former::text('city') }}
{{ Former::text('state')->label('State/Province') }}
{{ Former::text('postal_code') }}
@if(strtolower($gateway->name) == 'beanstream')
{{ Former::text('phone') }}
{{ Former::text('email') }}
{{ Former::select('country')->addOption('','')->label('Country') ->fromQuery($countries, 'name', 'iso_3166_2') }}
@endif
{{ Former::text('card_number') }}
{{ Former::select('expiration_month')->addOption('','') ->addOption('01 - January', '1') ->addOption('02 - February', '2') ->addOption('03 - March', '3') ->addOption('04 - April', '4') ->addOption('05 - May', '5') ->addOption('06 - June', '6') ->addOption('07 - July', '7') ->addOption('08 - August', '8') ->addOption('09 - September', '9') ->addOption('10 - October', '10') ->addOption('11 - November', '11') ->addOption('12 - December', '12') }}
{{ Former::select('expiration_year')->addOption('','') ->addOption('2014', '2014') ->addOption('2015', '2015') ->addOption('2016', '2016') ->addOption('2017', '2017') ->addOption('2018', '2018') ->addOption('2019', '2019') ->addOption('2020', '2020') }}
{{ Former::text('cvv') }}
{{ Button::block_primary_submit_lg(strtoupper(trans('texts.pay_now')) . ' - ' . Utils::formatMoney($amount, $currencyId) ) }}
{{ Former::close() }} @stop