<html><head>
    <meta charset="utf-8">
    <meta name="viewport" content="width=device-width, initial-scale=1">
    <script type="text/javascript" src="http://cdnjs.cloudflare.com/ajax/libs/jquery/2.0.3/jquery.min.js"></script>
    <script type="text/javascript" src="http://netdna.bootstrapcdn.com/bootstrap/3.3.4/js/bootstrap.min.js"></script>
    <link href="http://cdnjs.cloudflare.com/ajax/libs/font-awesome/4.3.0/css/font-awesome.min.css" rel="stylesheet" type="text/css">
    <link href="membership.css" rel="stylesheet" type="text/css">
  </head><body>
    <div class="section">
      <div class="container">
        <div class="row">
          <div class="col-md-2"></div>
          <div class="col-md-8">
            <h3 class="text-left text-muted">Payment details</h3>
            <hr>
            <div class="page-header text-muted" contenteditable="true">
              <h5>1 Year coworking membership &nbsp;(360 CHF)</h5>
              <h5>&nbsp; +2 free working days included &nbsp;(0 CHF)</h5>
              <div class="page-header text-muted">
                <h5>Valid 01.01.2016 - 31.12.2016&nbsp;</h5>
                <h5>Coworker Name&nbsp;: Nico Schottelius&nbsp;</h5>
              </div>
            </div>
            <div class="page-header text-muted">
              <h3 class="text-right">Total : 360 CHF</h3>
            </div>
            <form role="form">
              <div class="form-group">
                <label class="control-label" for="exampleInputEmail1">Name*</label>
                <input class="form-control" id="exampleInputEmail1" placeholder="Enter name on card" type="email">
              </div>
              <div class="form-group">
                <label class="control-label" for="exampleInputPassword1">Card Number*</label>
                <input class="form-control" id="exampleInputPassword1" placeholder="Card Number" type="text">
              </div>
            </form>
            <form role="form">
              <div class="form-group">
                <label class="control-label" for="exampleInputEmail1">Expiry Date*</label>
                <input class="form-control" id="exampleInputEmail1" placeholder="MM/YY" type="email">
              </div>
              <div class="form-group">
                <label class="control-label" for="exampleInputPassword1">CCV*</label>
                <input class="form-control" id="exampleInputPassword1" placeholder="CVV" type="password">
              </div>
              <button type="submit" class="btn btn-block btn-primary">Submit</button>
            </form>
            <a class="btn btn-block btn-info">Cancel</a>
          </div>
          <div class="col-md-2"></div>
        </div>
        <div class="row">
          <div class="col-md-11">
            <br>
            <p class="text-center text-muted">Have probelm? Contact
              <a href="">help@digitalglarus.ch.</a>
              <br>
              <br>
            </p>
          </div>
        </div>
      </div>
    </div>
  

</body></html>