BazaarBuilder E-commerce Software

Build Shop > Integrate Shop > offline_card_payment.htm

This template contains following 1 form to collect customer's credit card information. This page is used for Offline Credit Card payment method (Pay by Credit Card).

<form action="paymentpage.pl" method="post" onSubmit="MM_validateForm('Card Type','','R','Card Number','','R','Card Holder Name','','R','Card Holder Address','','R');return document.MM_returnValue"> <table border="0" align="center"> <tr> <td colspan="2" align="center" class="normal_heading_center">Credit Card Information</td> </tr> <tr> <td colspan="2" align="center" class="normal_heading_center"> </td> </tr> <tr> <td class="normal">Credit Card Type </td> <td> <select name="Card Type" class="input-txt" id="Card Type"> <option selected value="">--select--</option> <option value="MasterCard">MasterCard</option> <option value="Visa">Visa</option> <option value="American Express">American Express</option> <option value="Delta">Delta</option> <option value="Switch">Switch</option> </select> </td> </tr> <tr> <td class="normal">Credit Card Number </td> <td> <input name="Card Number" type="text" class="input-txt" id="Card Number" size="20" maxlength="20" autocomplete="OFF"> </td> </tr> <tr> <td class="normal">Valid From (month/year)</td> <td><select name="Start Month" id="Start Month"> <option value="" selected></option> <option value="1">01 </option> <option value="2">02 </option> <option value="3">03 </option> <option value="4">04 </option> <option value="5">05 </option> <option value="6">06 </option> <option value="7">07 </option> <option value="8">08 </option> <option value="9">09 </option> <option value="10">10 </option> <option value="11">11 </option> <option value="12">12 </option> </select> <select name="Start Year" id="Start Year"> <option value="" selected></option> <option value="1998">1998 </option> <option value="1999">1999 </option> <option value="2000">2000 </option> <option value="2001">2001 </option> <option value="2002">2002 </option> <option value="2003">2003 </option> <option value="2004">2004 </option> </select></td> </tr> <tr> <td class="normal">Expiry Date (month/year)</td> <td><select name="Expiry Month" id="Expiry Month"> <option value="" selected></option> <option value="1">01 </option> <option value="2">02 </option> <option value="3">03 </option> <option value="4">04 </option> <option value="5">05 </option> <option value="6">06 </option> <option value="7">07 </option> <option value="8">08 </option> <option value="9">09 </option> <option value="10">10 </option> <option value="11">11 </option> <option value="12">12 </select> <select name="Expiry Year" id="Expiry Year"> <option value="" selected></option> <option value="2003">2003 </option> <option value="2004">2004 </option> <option value="2005">2005 </option> <option value="2006">2006 </option> <option value="2007">2007 </option> <option value="2008">2008 </option> <option value="2009">2009 </option> <option value="2010">2010 </option> <option value="2011">2011 </option> <option value="2012">2012 </option> <option value="2013">2013 </option></select></td> </tr> <tr> <td class="normal">Issue Number</td> <td><input name="Issue Number" type="text" class="input-txt" id="Issue Number" size="20" maxlength="20" autocomplete="OFF"></td> </tr> <tr> <td class="normal">Security Code</td> <td><input name="Security Code" type="text" class="input-txt" id="Security Code" size="20" maxlength="9" autocomplete="OFF"></td> </tr> <tr> <td class="normal">Cardholder's Name</td> <td> <input name="Card Holder Name" type="text" class="input-txt" id="Card Holder Name" size="20" maxlength="50" autocomplete="OFF"> </td> </tr> <tr> <td class="normal"> Address</td> <td> <input name="Card Holder Address" type="text" class="input-txt" id="Card Holder Address" size="20" maxlength="150" autocomplete="OFF"> </td> </tr> <tr> <td colspan=2 align="center"><input name="customerId" type="hidden" id="customerId" value="<tmpl_var customerId>"> <input name="cost" type="hidden" id="cost" value="<tmpl_var cost>"> <input name="fname" type="hidden" id="fname" value="<tmpl_var fname>"> <input name="lname" type="hidden" id="lname" value="<tmpl_var lname>"> <input name="city" type="hidden" id="city" value="<tmpl_var city>"> <input name="postcode" type="hidden" id="postcode" value="<tmpl_var postcode>"> <input name="address" type="hidden" id="address" value="<tmpl_var address>"> <input name="country" type="hidden" id="country" value="<tmpl_var country>"> <input name="country_code" type="hidden" id="country_code" value="<tmpl_var country_code>"> <input name="tele" type="hidden" id="tele" value="<tmpl_var tele>"> <input name="fax" type="hidden" id="fax" value="<tmpl_var fax>"> <input name="email" type="hidden" id="email" value="<tmpl_var email>"> <input name="cart_id" type="hidden" id="cart_id" value="<tmpl_var cart_id>"> <input name="nettotal" type="hidden" id="nettotal" value="<tmpl_var nettotal>"> <input name="vat" type="hidden" id="vat" value="<tmpl_var vat>"> <input name="asd" type="hidden" id="asd" value="<tmpl_var asd>"> <input name="service" type="hidden" id="service" value="<tmpl_var service>"> <input name="shippingvat" type="hidden" id="shippingvat" value="<tmpl_var shippingvat>"> <input name="payment_method" type="hidden" id="payment_method" value="<tmpl_var payment_method>"> <input type="hidden" name="curr_id" value="<tmpl_var curr_id>"></td> </tr> <tr> <td colspan=2 align="right"> </td> </tr> <tr> <td colspan=2 align="right"> <input type="submit" class="button" value="Submit"> </td> </tr> </table> </form>

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