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Merge pull request #12 from heidelpay/feature/PLENTY-81/add-iv-sec-to…
…-config feature/PLENTY-81/add-iv-sec-to-config
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Original file line number | Diff line number | Diff line change |
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{% extends "Heidelpay::base" %} | ||
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{% block content %} | ||
<form action="{{ submit_action }}" id="heidelpay-payment-form" method="post"> | ||
<div class="row"> | ||
<div class="col-md-4"></div> | ||
<div class="col-md-2"> | ||
<label for="salutation" class="required">{{ trans('Heidelpay::template.salutation') }} <em>*</em></label> | ||
</div> | ||
<div class="col-md-2"> | ||
<select id="salutation" required> | ||
<option value="" disabled selected>{{ trans('Heidelpay::template.choose') }}</option> | ||
<option value="mr">{{ trans('Heidelpay::template.mr') }}</option> | ||
<option value="mrs">{{ trans('Heidelpay::template.mrs') }}</option> | ||
</select> | ||
</div> | ||
<div class="col-md-4"></div> | ||
</div> | ||
<div class="row"> | ||
<div class="col-md-4"></div> | ||
<div class="col-md-2"> | ||
<label for="dateofbirth" class="required">{{ trans('Heidelpay::template.birthday') }} <em>*</em></label> | ||
</div> | ||
<div class="col-md-1"> | ||
<div class="input-box" style="width:100%"> | ||
<select id="dob_day" required> | ||
<option disabled selected value="">{{ trans('Heidelpay::template.day') }}</option> | ||
<option value="01">01</option><option value="02">02</option><option value="03">03</option> | ||
<option value="04">04</option><option value="05">05</option><option value="06">06</option> | ||
<option value="07">07</option><option value="08">08</option><option value="09">09</option> | ||
<option value="10">10</option><option value="11">11</option><option value="12">12</option> | ||
<option value="13">13</option><option value="14">14</option><option value="15">15</option> | ||
<option value="16">16</option><option value="17">17</option><option value="18">18</option> | ||
<option value="19">19</option><option value="20">20</option><option value="21">21</option> | ||
<option value="22">22</option><option value="23">23</option><option value="24">24</option> | ||
<option value="25">25</option><option value="26">26</option><option value="27">27</option> | ||
<option value="28">28</option><option value="29">29</option><option value="30">30</option> | ||
<option value="31">31</option> | ||
</select> | ||
</div> | ||
</div> | ||
<div class="col-md-1"> | ||
<div class="input-box" style="width:100%"> | ||
<select title="dob_month" required> | ||
<option disabled selected value="">{{ trans('Heidelpay::template.month') }}</option> | ||
<option value="01">01</option><option value="02">02</option><option value="03">03</option> | ||
<option value="04">04</option><option value="05">05</option><option value="06">06</option> | ||
<option value="07">07</option><option value="08">08</option><option value="09">09</option> | ||
<option value="10">10</option><option value="11">11</option><option value="12">12</option> | ||
</select> | ||
</div> | ||
</div> | ||
<div class="col-md-1"> | ||
<div class="input-box" style="width:100%"> | ||
<select id="dob_year" required> | ||
<option disabled selected value="">{{ trans('Heidelpay::template.year') }}</option> | ||
{% set minYear = "now -80 years"|date("Y") %} | ||
{% set maxYear = "now -18 years"|date("Y") %} | ||
<ul> | ||
{% for year in maxYear..minYear %} | ||
<option value="{{ year }}">{{ year }}</option> | ||
{% endfor %} | ||
</ul> | ||
</select> | ||
</div> | ||
</div> | ||
<div class="col-md-3"></div> | ||
</div> | ||
{% include "Heidelpay::partials/cancelSubmitButtons" %} | ||
</form> | ||
{% endblock %} | ||
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{% block scripts %} | ||
{% endblock %} |
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