1 <div class="modal-header">
2 <button type="button" class="close"
3 ng-click="cancel()" aria-hidden="true">×</button>
4 <h4 class="modal-title">
5 [% l('Credit Card Information') %]
8 <div class="modal-body tight-vert-form" id="patron-pay-by-credit-form">
9 <div class="panel panel-default">
10 <div class="panel-heading">[% l('Credit Card Info') %]</div>
11 <div class="panel-body">
12 <div class="row form-group">
13 <div class="col-md-4"><label>[% l('Process Where?') %]</label></div>
14 <div class="col-md-8">
15 <select class="form-control" ng-model="context.cc.where_process">
17 [% l('Process payment through Evergreen') %]</option>
19 [% l('Record externally processed payment') %]</option>
23 <!-- wrapper div for internal CC processing fields -->
24 <div ng-if="context.cc.where_process == '1'">
25 <div class="row form-group">
26 <div class="col-md-4"><label>[% l('Credit Card Number') %]</label></div>
27 <div class="col-md-8">
28 <input type='text' class="form-control" ng-model="context.cc.number"/>
31 <div class="row form-group">
32 <div class="col-md-4"><label>[% l('Expire Month') %]</label></div>
33 <div class="col-md-8">
34 <input type='number' class="form-control" ng-model="context.cc.expire_month"/>
37 <div class="row form-group">
38 <div class="col-md-4"><label>[% l('Expire Year') %]</label></div>
39 <div class="col-md-8">
40 <input type='number' class="form-control" ng-model="context.cc.expire_year"/>
43 </div><!--cc-internal-wrapper-->
44 <div ng-if="context.cc.where_process == '0'">
45 <div class="row form-group">
46 <div class="col-md-4"><label>[% l('Approval Code') %]</label></div>
47 <div class="col-md-8">
48 <input type='text' class="form-control"
49 required ng-model="context.cc.approval_code"/>
52 </div><!--cc-external-wrapper-->
53 </div><!--panel-body-->
55 <div class="panel panel-default">
56 <div class="panel-heading">[% l('Optional Fields') %]</div>
57 <div class="panel-body">
58 <div class="row form-group">
59 <div class="col-md-4"><label>[% l('Billing Name (first)') %]</label></div>
60 <div class="col-md-8">
61 <input type='text' class="form-control"
62 ng-model="context.cc.billing_first"/>
65 <div class="row form-group">
66 <div class="col-md-4"><label>[% l('Billing Name (last)') %]</label></div>
67 <div class="col-md-8">
68 <input type='text' class="form-control"
69 ng-model="context.cc.billing_last"/>
72 <div ng-if="context.cc.where_process == '1'">
73 <div class="row form-group">
74 <div class="col-md-4"><label>[% l('Address') %]</label></div>
75 <div class="col-md-8">
76 <input type='text' class="form-control"
77 ng-model="context.cc.billing_address"/>
80 <div class="row form-group">
81 <div class="col-md-4"><label>[% l('City, town or village') %]</label></div>
82 <div class="col-md-8">
83 <input type='text' class="form-control"
84 ng-model="context.cc.billing_city"/>
87 <div class="row form-group">
88 <div class="col-md-4"><label>[% l('State or province') %]</label></div>
89 <div class="col-md-8">
90 <input type='text' class="form-control"
91 ng-model="context.cc.billing_state"/>
94 <div class="row form-group">
95 <div class="col-md-4"><label>[% l('ZIP or postal code') %]</label></div>
96 <div class="col-md-8">
97 <input type='text' class="form-control"
98 ng-model="context.cc.billing_zip"/>
101 </div><!--cc-internal-wrapper-->
102 <div class="row form-group">
103 <div class="col-md-4"><label>[% l('Note') %]</label></div>
104 <div class="col-md-8">
105 <textarea rows="2" type='text' class="form-control"
106 ng-model="context.cc.note"></textarea>
109 </div><!--panel-body-->
111 </div><!--modal-body-->
112 <div class="modal-footer">
113 <button class="btn btn-primary" ng-click="ok()" ng-disabled="context.cc.where_process == 0 && !context.cc.approval_code">[% l('Submit') %]</button>
114 <button class="btn btn-warning" ng-click="cancel()">[% l('Cancel') %]</button>