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">
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('Credit Card Type') %]</label></div>
47 <div class="col-md-8">
48 <select class="form-control" ng-model="context.cc.type">
49 <option value='VISA'>[% l('VISA') %]</option>
50 <option value='MasterCard'>[% l('Mastercard') %]</option>
51 <option value='American Express'>[% l('American Express') %]</option>
52 <option value='Discover'>[% l('Discover') %]</option>
53 <option value='Other'>[% l('Other') %]</option>
57 <div class="row form-group">
58 <div class="col-md-4"><label>[% l('Approval Code') %]</label></div>
59 <div class="col-md-8">
60 <input type='text' class="form-control" ng-model="context.cc.approval_code"/>
63 </div><!--cc-external-wrapper-->
64 </div><!--panel-body-->
66 <div class="panel panel-default">
67 <div class="panel-heading">[% l('Optional Fields') %]</div>
68 <div class="panel-body">
69 <div class="row form-group">
70 <div class="col-md-4"><label>[% l('Billing Name (first)') %]</label></div>
71 <div class="col-md-8">
72 <input type='text' class="form-control"
73 ng-model="context.cc.billing_first"/>
76 <div class="row form-group">
77 <div class="col-md-4"><label>[% l('Billing Name (last)') %]</label></div>
78 <div class="col-md-8">
79 <input type='text' class="form-control"
80 ng-model="context.cc.billing_last"/>
83 <div ng-if="context.cc.where_process == '1'">
84 <div class="row form-group">
85 <div class="col-md-4"><label>[% l('Address') %]</label></div>
86 <div class="col-md-8">
87 <input type='text' class="form-control"
88 ng-model="context.cc.billing_address"/>
91 <div class="row form-group">
92 <div class="col-md-4"><label>[% l('City, town or village') %]</label></div>
93 <div class="col-md-8">
94 <input type='text' class="form-control"
95 ng-model="context.cc.billing_city"/>
98 <div class="row form-group">
99 <div class="col-md-4"><label>[% l('State or province') %]</label></div>
100 <div class="col-md-8">
101 <input type='text' class="form-control"
102 ng-model="context.cc.billing_state"/>
105 <div class="row form-group">
106 <div class="col-md-4"><label>[% l('ZIP or postal code') %]</label></div>
107 <div class="col-md-8">
108 <input type='text' class="form-control"
109 ng-model="context.cc.billing_zip"/>
112 </div><!--cc-internal-wrapper-->
113 <div class="row form-group">
114 <div class="col-md-4"><label>[% l('Note') %]</label></div>
115 <div class="col-md-8">
116 <textarea rows="2" type='text' class="form-control"
117 ng-model="context.cc.note"></textarea>
120 </div><!--panel-body-->
122 </div><!--modal-body-->
123 <div class="modal-footer">
124 <button class="btn btn-primary" ng-click="ok()">[% l('Submit') %]</button>
125 <button class="btn btn-warning" ng-click="cancel()">[% l('Cancel') %]</button>