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<form class="form-horizontal"><fieldset id="payment"><legend>{{ text_credit_card }}</legend><div class="form-group required"><label class="col-sm-2 control-label" for="input-cc-type">{{ entry_cc_type }}</label><div class="col-sm-10"><select name="cc_type" id="input-cc-type" class="form-control">{% for card in cards %}<option value="{{ card.value }}">{{ card.text }}</option>{% endfor %}</select></div></div><div class="form-group required"><label class="col-sm-2 control-label" for="input-cc-number">{{ entry_cc_number }}</label><div class="col-sm-10"><input type="text" name="cc_number" value="" placeholder="{{ entry_cc_number }}" id="input-cc-number" class="form-control" /></div></div><div class="form-group"><label class="col-sm-2 control-label" for="input-cc-start-date"><span data-toggle="tooltip" title="{{ help_start_date }}">{{ entry_cc_start_date }}</span></label><div class="col-sm-3"><select name="cc_start_date_month" id="input-cc-start-date" class="form-control">{% for month in months %}<option value="{{ month.value }}">{{ month.text }}</option>{% endfor %}</select></div><div class="col-sm-3"><select name="cc_start_date_year" class="form-control">{% for year in year_valid %}<option value="{{ year.value }}">{{ year.text }}</option>{% endfor %}</select></div></div><div class="form-group required"><label class="col-sm-2 control-label" for="input-cc-expire-date">{{ entry_cc_expire_date }}</label><div class="col-sm-3"><select name="cc_expire_date_month" id="input-cc-expire-date" class="form-control">{% for month in months %}<option value="{{ month.value }}">{{ month.text }}</option>{% endfor %}</select></div><div class="col-sm-3"><select name="cc_expire_date_year" class="form-control">{% for year in year_expire %}<option value="{{ year.value }}">{{ year.text }}</option>{% endfor %}</select></div></div><div class="form-group required"><label class="col-sm-2 control-label" for="input-cc-cvv2">{{ entry_cc_cvv2 }}</label><div class="col-sm-10"><input type="text" name="cc_cvv2" value="" placeholder="{{ entry_cc_cvv2 }}" id="input-cc-cvv2" class="form-control" /></div></div><div class="form-group"><label class="col-sm-2 control-label" for="input-cc-issue"><span data-toggle="tooltip" title="{{ help_issue }}">{{ entry_cc_issue }}</span></label><div class="col-sm-10"><input type="text" name="cc_issue" value="" placeholder="{{ entry_cc_issue }}" id="input-cc-issue" class="form-control" /></div></div></fieldset></form><div class="buttons"><div class="pull-right"><input type="button" value="{{ button_confirm }}" id="button-confirm" data-loading-text="{{ text_loading }}" class="btn btn-primary" /></div></div><script type="text/javascript"><!--$('#button-confirm').bind('click', function() {$.ajax({url: 'index.php?route=extension/payment/pp_pro/send',type: 'post',data: $('#payment :input'),dataType: 'json',beforeSend: function() {$('#button-confirm').attr('disabled', true);$('#payment').before('<div class="alert alert-info"><i class="fa fa-info-circle"></i> {{ text_wait }}</div>');},complete: function() {$('.alert-dismissible').remove();$('#button-confirm').attr('disabled', false);},success: function(json) {if (json['error']) {alert(json['error']);}if (json['success']) {location = json['success'];}}});});//--></script>