74 lines
3.3 KiB
HTML
74 lines
3.3 KiB
HTML
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<html><head>
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<meta charset="utf-8">
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<meta name="viewport" content="width=device-width, initial-scale=1">
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<script type="text/javascript" src="http://cdnjs.cloudflare.com/ajax/libs/jquery/2.0.3/jquery.min.js"></script>
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<script type="text/javascript" src="http://netdna.bootstrapcdn.com/bootstrap/3.3.4/js/bootstrap.min.js"></script>
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<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="http://pingendo.github.io/pingendo-bootstrap/themes/default/bootstrap.css" rel="stylesheet" type="text/css">
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</head><body>
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<div class="section">
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<div class="container">
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<div class="row">
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<div class="col-md-2"></div>
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<div class="col-md-8">
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<h1 class="text-left text-muted">Payment details</h1>
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<hr>
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<div class="page-header text-muted" contenteditable="true">
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<h3>1 Year coworking membership (360 CHF)</h3>
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<h3>
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+2 free working days included (0 CHF)</h3><div class="page-header text-muted">
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<h3>Valid 01.01.2016 - 31.12.2016 </h3>
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<h3>
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Coworker Name : Nico Schottelius
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</h3>
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</div>
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</div>
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<div class="page-header text-muted">
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<h1 class="text-right">Total : 360 CHF
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<font color="#777777">
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<span style="font-size: 23.3999996185303px; line-height: 23.3999996185303px;"></span>
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</font>
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</h1>
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</div>
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<form role="form">
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<div class="form-group">
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<label class="control-label" for="exampleInputEmail1">Name*</label>
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<input class="form-control" id="exampleInputEmail1" placeholder="Enter name on card" type="email">
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</div>
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<div class="form-group">
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<label class="control-label" for="exampleInputPassword1">Card Number*</label>
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<input class="form-control" id="exampleInputPassword1" placeholder="Card Number" type="text">
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</div>
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</form>
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<form role="form">
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<div class="form-group">
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<label class="control-label" for="exampleInputEmail1">Expiry Date*</label>
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<input class="form-control" id="exampleInputEmail1" placeholder="MM/YY" type="email">
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</div>
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<div class="form-group">
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<label class="control-label" for="exampleInputPassword1">CCV*</label>
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<input class="form-control" id="exampleInputPassword1" placeholder="CVV" type="password">
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</div>
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<button type="submit" class="btn btn-block btn-primary">Submit</button>
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</form>
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<a class="btn btn-block btn-info">Cancel</a>
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</div>
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<div class="col-md-2"></div>
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</div>
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<div class="row">
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<div class="col-md-11">
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<br>
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<p class="text-center text-muted">Have probelm? Contact
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<a href="">help@digitalglarus.ch.</a>
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<br>
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<br>
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</p>
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</div>
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</div>
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</div>
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</div>
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</body></html>
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