dynamicweb/non_django_but_related/design_membership/creditcard.html

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<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">
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<link href="membership.css" rel="stylesheet" type="text/css">
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</head><body>
<div class="section">
<div class="container">
<div class="row">
<div class="col-md-2"></div>
<div class="col-md-8">
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<h3 class="text-left text-muted">Payment details</h3>
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<hr>
<div class="page-header text-muted" contenteditable="true">
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<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>
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</div>
<div class="page-header text-muted">
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<h3 class="text-right">Total : 360 CHF</h3>
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</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>