@extends('layouts.master') @section('title','Review Supplier') @section('content') @include('partials.headerbanner',['title'=> 'Subscription Plan Form','banner' => asset('images/product-list-bnr.jpg')]) @include('partials.header')

{{ 'Subscription Plan Form' }}

@include('layouts.admin.flash.alert') {!! Form::open(['url'=>route('subscription.store',$plan->id), 'id'=>'form', 'method'=>'POST', 'role'=>'form', 'id'=>'card-form']) !!}
{!! Form::label('name_on_card', 'Name on card'.config('site.form.colon'), ['class' => '']) !!} {!! config('site.form.required') !!} {!! Form::text('name_on_card', null, ['data-stripe'=>'name', 'placeholder' => 'Name on card', 'required'=>'required','class'=>'form-control']) !!} {{ $errors->first('name_on_card', ':message') }}
{!! Form::label('card_number', 'Card number'.config('site.form.colon'), ['class' => '']) !!} {!! config('site.form.required') !!} {!! Form::number('card_number', null, ['data-stripe'=>'number', 'placeholder' => 'Card number','maxlength'=>16, 'required'=>'required','data-inputmask'=>"'mask': '9999999999999999'",'data-mask','class'=>'form-control numeric-field']) !!} {{ $errors->first('card_number', ':message') }}
{!! Form::label('expiry_month', 'Month', ['class' => '']) !!} {!! Form::selectMonth('expiry_month', null, ['data-stripe'=>'exp_month','class'=>'form-control']) !!} {{ $errors->first('expiry_month', ':message') }}
{!! Form::label('expiry_year', 'Year', ['class' => '']) !!} {!! Form::selectYear('expiry_year', date('Y'), date('Y') + 10, null, ['data-stripe'=>'exp_year','class'=>'form-control']) !!} {{ $errors->first('expiry_year', ':message') }}
{!! Form::label('cvc', 'CCV'.config('site.form.colon'), ['class' => '']) !!} {!! config('site.form.required') !!} {!! Form::password('cvc', ['data-stripe'=>'cvc', 'onkeypress'=> 'return common.isNumber(event)', 'placeholder' => 'CCV', 'maxlength'=>4, 'required'=>'required','class'=>'form-control']) !!} {{ $errors->first('cvc', ':message') }}
{!! Form::submit('Continue', ['id'=>'cardBtn','class'=>'btn btn-custom btn-sm green-btn']) !!}
{{ Form::close() }} @stop @section('script_per_page') {!! Html::script('https://js.stripe.com/v2/') !!} @stop