<html lang="en"><head>
<meta http-equiv="Content-type" content="text/html; charset=utf-8">
<meta name="viewport" content="width=device-width, initial-scale=1">
<title>Secure Payment Form</title>
<link rel="stylesheet" href="css/bootstrap-min.css">
<link rel="stylesheet" href="css/bootstrap-formhelpers-min.css" media="screen">
<link rel="stylesheet" href="css/bootstrapValidator-min.css">
<link rel="stylesheet" href="https://netdna.bootstrapcdn.com/font-awesome/4.0.3/css/font-awesome.css">
<link rel="stylesheet" href="css/bootstrap-side-notes.css">
<style type="text/css">
.col-centered {
display:inline-block;
float:none;
text-align:left;
margin-right:-4px;
}
.row-centered {
margin-left: 9px;
margin-right: 9px;
}
</style>
<script type="text/javascript" src="https://js.stripe.com/v2/"></script>
<script src="https://ajax.googleapis.com/ajax/libs/jquery/1.11.0/jquery.min.js"></script>
<script src="js/bootstrap-min.js"></script>
<script src="js/bootstrap-formhelpers-min.js"></script>
<script type="text/javascript" src="js/bootstrapValidator-min.js"></script>
<script type="text/javascript">
$(document).ready(function() {
$('#payment-form').bootstrapValidator({
message: 'This value is not valid',
feedbackIcons: {
valid: 'glyphicon glyphicon-ok',
invalid: 'glyphicon glyphicon-remove',
validating: 'glyphicon glyphicon-refresh'
},
submitHandler: function(validator, form, submitButton) {
Stripe.card.createToken({
number: $('.card-number').val(),
cvc: $('.card-cvc').val(),
exp_month: $('.card-expiry-month').val(),
exp_year: $('.card-expiry-year').val(),
name: $('.card-holder-name').val(),
address_line1: $('.address').val(),
address_city: $('.city').val(),
address_zip: $('.zip').val(),
address_state: $('.state').val(),
address_country: $('.country').val()
}, stripeResponseHandler);
return false;
},
fields: {
street: {
validators: {
notEmpty: {
message: 'The street is required and cannot be empty'
},
stringLength: {
min: 6,
max: 96,
message: 'The street must be more than 6 and less than 96 characters long'
}
}
},
city: {
validators: {
notEmpty: {
message: 'The city is required and cannot be empty'
}
}
},
zip: {
validators: {
notEmpty: {
message: 'The zip is required and cannot be empty'
},
stringLength: {
min: 3,
max: 9,
message: 'The zip must be more than 3 and less than 9 characters long'
}
}
},
email: {
validators: {
notEmpty: {
message: 'The email address is required and can\'t be empty'
},
emailAddress: {
message: 'The input is not a valid email address'
},
stringLength: {
min: 6,
max: 65,
message: 'The email must be more than 6 and less than 65 characters long'
}
}
},
cardholdername: {
validators: {
notEmpty: {
message: 'The card holder name is required and can\'t be empty'
},
stringLength: {
min: 6,
max: 70,
message: 'The card holder name must be more than 6 and less than 70 characters long'
}
}
},
cardnumber: {
selector: '#cardnumber',
validators: {
notEmpty: {
message: 'The credit card number is required and can\'t be empty'
},
creditCard: {
message: 'The credit card number is invalid'
},
}
},
expMonth: {
selector: '[data-stripe="exp-month"]',
validators: {
notEmpty: {
message: 'The expiration month is required'
},
digits: {
message: 'The expiration month can contain digits only'
},
callback: {
message: 'Expired',
callback: function(value, validator) {
value = parseInt(value, 10);
var year = validator.getFieldElements('expYear').val(),
currentMonth = new Date().getMonth() + 1,
currentYear = new Date().getFullYear();
if (value < 0 || value > 12) {
return false;
}
if (year == '') {
return true;
}
year = parseInt(year, 10);
if (year > currentYear || (year == currentYear && value > currentMonth)) {
validator.updateStatus('expYear', 'VALID');
return true;
} else {
return false;
}
}
}
}
},
expYear: {
selector: '[data-stripe="exp-year"]',
validators: {
notEmpty: {
message: 'The expiration year is required'
},
digits: {
message: 'The expiration year can contain digits only'
},
callback: {
message: 'Expired',
callback: function(value, validator) {
value = parseInt(value, 10);
var month = validator.getFieldElements('expMonth').val(),
currentMonth = new Date().getMonth() + 1,
currentYear = new Date().getFullYear();
if (value < currentYear || value > currentYear + 100) {
return false;
}
if (month == '') {
return false;
}
month = parseInt(month, 10);
if (value > currentYear || (value == currentYear && month > currentMonth)) {
validator.updateStatus('expMonth', 'VALID');
return true;
} else {
return false;
}
}
}
}
},
cvv: {
selector: '#cvv',
validators: {
notEmpty: {
message: 'The cvv is required and can\'t be empty'
},
cvv: {
message: 'The value is not a valid CVV',
creditCardField: 'cardnumber'
}
}
},
}
});
});
</script>
<script type="text/javascript">
Stripe.setPublishableKey('pk_test_xxx');
function stripeResponseHandler(status, response) {
if (response.error) {
$('.submit-button').removeAttr("disabled");
document.getElementById('a_x200').style.display = 'block';
$(".payment-errors").html(response.error.message);
} else {
var form$ = $("#payment-form");
var token = response['id'];
form$.append("<input type='hidden' name='stripeToken' value='" + token + "' />");
form$.get(0).submit();
}
}
</script>
</head>
<body>
<form action="/post.php" method="POST" id="payment-form" class="form-horizontal bootstrap-validator-form" novalidate="novalidate">
<div class="row row-centered">
<div class="col-md-4 col-md-offset-4">
<div class="page-header">
<h2 class="gdfg">Secure Payment Form</h2>
</div>
<noscript>
<div class="bs-callout bs-callout-danger">
<h4>JavaScript is not enabled!</h4>
<p>This payment form requires your browser to have JavaScript enabled. Please activate JavaScript and reload this page. Check <a href="http://enable-javascript.com" target="_blank">enable-javascript.com</a> for more informations.</p>
</div>
</noscript>
<div class="alert alert-danger" id="a_x200" style="display: none;"> <strong>Error!</strong> <span class="payment-errors"></span> </div>
<span class="payment-success">
</span>
<fieldset>
<legend>Billing Details</legend>
<div class="form-group has-feedback">
<label class="col-sm-4 control-label" for="textinput">Street</label>
<div class="col-sm-6">
<input type="text" name="street" placeholder="Street" class="address form-control" data-bv-field="street"><i class="form-control-feedback" data-bv-field="street" style="display: none;"></i>
<small data-bv-validator="notEmpty" class="help-block" style="display: none;">The street is required and cannot be empty</small><small data-bv-validator="stringLength" class="help-block" style="display: none;">The street must be more than 6 and less than 96 characters long</small></div>
</div>
<div class="form-group has-feedback">
<label class="col-sm-4 control-label" for="textinput">City</label>
<div class="col-sm-6">
<input type="text" name="city" placeholder="City" class="city form-control" data-bv-field="city"><i class="form-control-feedback" data-bv-field="city" style="display: none;"></i>
<small data-bv-validator="notEmpty" class="help-block" style="display: none;">The city is required and cannot be empty</small></div>
</div>
<div class="form-group has-feedback">
<label class="col-sm-4 control-label" for="textinput">State</label>
<div class="col-sm-6">
<input type="text" name="state" maxlength="65" placeholder="State" class="state form-control" data-bv-field="state"><i class="form-control-feedback" data-bv-field="state" style="display: none;"></i>
<small data-bv-validator="stringLength" class="help-block" style="display: none;">This value is not valid</small></div>
</div>
<div class="form-group has-feedback">
<label class="col-sm-4 control-label" for="textinput">Postal Code</label>
<div class="col-sm-6">
<input type="text" name="zip" maxlength="9" placeholder="Postal Code" class="zip form-control" data-bv-field="zip"><i class="form-control-feedback" data-bv-field="zip" style="display: none;"></i>
<small data-bv-validator="notEmpty" class="help-block" style="display: none;">The zip is required and cannot be empty</small><small data-bv-validator="stringLength" class="help-block" style="display: none;">The zip must be more than 3 and less than 9 characters long</small></div>
</div>
<div class="form-group has-feedback">
<label class="col-sm-4 control-label" for="textinput">Country</label>
<div class="col-sm-6">
<div class="country bfh-selectbox bfh-countries" name="country" placeholder="Select Country" data-flags="true" data-filter="true" data-bv-field="country"><input type="hidden" name="" value=""><a class="bfh-selectbox-toggle form-control" role="button" data-toggle="bfh-selectbox" href="#"><span class="bfh-selectbox-option"></span><span class="caret selectbox-caret"></span></a><div class="bfh-selectbox-options"><div class="bfh-selectbox-filter-container"><input type="text" class="bfh-selectbox-filter form-control"></div><div role="listbox"><ul role="option"><li><a tabindex="-1" href="#" data-option=""></a></li><li><a tabindex="-1" href="#" data-option="AF"><i class="glyphicon bfh-flag-AF"></i>Afghanistan</a></li><li><a tabindex="-1" href="#" data-option="AL"><i class="glyphicon bfh-flag-AL"></i>Albania</a></li><li><a tabindex="-1" href="#" data-option="DZ"><i class="glyphicon bfh-flag-DZ"></i>Algeria</a></li><li><a tabindex="-1" href="#" data-option="AS"><i class="glyphicon bfh-flag-AS"></i>American Samoa</a></li><li><a tabindex="-1" href="#" data-option="AD"><i class="glyphicon bfh-flag-AD"></i>Andorra</a></li><li><a tabindex="-1" href="#" data-option="AO"><i class="glyphicon bfh-flag-AO"></i>Angola</a></li><li><a tabindex="-1" href="#" data-option="AI"><i class="glyphicon bfh-flag-AI"></i>Anguilla</a></li><li><a tabindex="-1" href="#" data-option="AQ"><i class="glyphicon bfh-flag-AQ"></i>Antarctica</a></li><li><a tabindex="-1" href="#" data-option="AG"><i class="glyphicon bfh-flag-AG"></i>Antigua and Barbuda</a></li><li><a tabindex="-1" href="#" data-option="AR"><i class="glyphicon bfh-flag-AR"></i>Argentina</a></li><li><a tabindex="-1" href="#" data-option="AM"><i class="glyphicon bfh-flag-AM"></i>Armenia</a></li><li><a tabindex="-1" href="#" data-option="AW"><i class="glyphicon bfh-flag-AW"></i>Aruba</a></li><li><a tabindex="-1" href="#" data-option="AU"><i class="glyphicon bfh-flag-AU"></i>Australia</a></li><li><a tabindex="-1" href="#" data-option="AT"><i class="glyphicon bfh-flag-AT"></i>Austria</a></li><li><a tabindex="-1" href="#" data-option="AZ"><i class="glyphicon bfh-flag-AZ"></i>Azerbaijan</a></li><li><a tabindex="-1" href="#" data-option="BH"><i class="glyphicon bfh-flag-BH"></i>Bahrain</a></li><li><a tabindex="-1" href="#" data-option="BD"><i class="glyphicon bfh-flag-BD"></i>Bangladesh</a></li><li><a tabindex="-1" href="#" data-option="BB"><i class="glyphicon bfh-flag-BB"></i>Barbados</a></li><li><a tabindex="-1" href="#" data-option="BY"><i class="glyphicon bfh-flag-BY"></i>Belarus</a></li><li><a tabindex="-1" href="#" data-option="BE"><i class="glyphicon bfh-flag-BE"></i>Belgium</a></li><li><a tabindex="-1" href="#" data-option="BZ"><i class="glyphicon bfh-flag-BZ"></i>Belize</a></li><li><a tabindex="-1" href="#" data-option="BJ"><i class="glyphicon bfh-flag-BJ"></i>Benin</a></li><li><a tabindex="-1" href="#" data-option="BM"><i class="glyphicon bfh-flag-BM"></i>Bermuda</a></li><li><a tabindex="-1" href="#" data-option="BT"><i class="glyphicon bfh-flag-BT"></i>Bhutan</a></li><li><a tabindex="-1" href="#" data-option="BO"><i class="glyphicon bfh-flag-BO"></i>Bolivia</a></li><li><a tabindex="-1" href="#" data-option="BA"><i class="glyphicon bfh-flag-BA"></i>Bosnia and Herzegovina</a></li><li><a tabindex="-1" href="#" data-option="BW"><i class="glyphicon bfh-flag-BW"></i>Botswana</a></li><li><a tabindex="-1" href="#" data-option="BV"><i class="glyphicon bfh-flag-BV"></i>Bouvet Island</a></li><li><a tabindex="-1" href="#" data-option="BR"><i class="glyphicon bfh-flag-BR"></i>Brazil</a></li><li><a tabindex="-1" href="#" data-option="IO"><i class="glyphicon bfh-flag-IO"></i>British Indian Ocean Territory</a></li><li><a tabindex="-1" href="#" data-option="VG"><i class="glyphicon bfh-flag-VG"></i>British Virgin Islands</a></li><li><a tabindex="-1" href="#" data-option="BN"><i class="glyphicon bfh-flag-BN"></i>Brunei</a></li><li><a tabindex="-1" href="#" data-option="BG"><i class="glyphicon bfh-flag-BG"></i>Bulgaria</a></li><li><a tabindex="-1" href="#" data-option="BF"><i class="glyphicon bfh-flag-BF"></i>Burkina Faso</a></li><li><a tabindex="-1" href="#" data-option="BI"><i class="glyphicon bfh-flag-BI"></i>Burundi</a></li><li><a tabindex="-1" href="#" data-option="CI"><i class="glyphicon bfh-flag-CI"></i>Côte d'Ivoire</a></li><li><a tabindex="-1" href="#" data-option="KH"><i class="glyphicon bfh-flag-KH"></i>Cambodia</a></li><li><a tabindex="-1" href="#" data-option="CM"><i class="glyphicon bfh-flag-CM"></i>Cameroon</a></li><li><a tabindex="-1" href="#" data-option="CA"><i class="glyphicon bfh-flag-CA"></i>Canada</a></li><li><a tabindex="-1" href="#" data-option="CV"><i class="glyphicon bfh-flag-CV"></i>Cape Verde</a></li><li><a tabindex="-1" href="#" data-option="KY"><i class="glyphicon bfh-flag-KY"></i>Cayman Islands</a></li><li><a tabindex="-1" href="#" data-option="CF"><i class="glyphicon bfh-flag-CF"></i>Central African Republic</a></li><li><a tabindex="-1" href="#" data-option="TD"><i class="glyphicon bfh-flag-TD"></i>Chad</a></li><li><a tabindex="-1" href="#" data-option="CL"><i class="glyphicon bfh-flag-CL"></i>Chile</a></li><li><a tabindex="-1" href="#" data-option="CN"><i class="glyphicon bfh-flag-CN"></i>China</a></li><li><a tabindex="-1" href="#" data-option="CX"><i class="glyphicon bfh-flag-CX"></i>Christmas Island</a></li><li><a tabindex="-1" href="#" data-option="CC"><i class="glyphicon bfh-flag-CC"></i>Cocos (Keeling) Islands</a></li><li><a tabindex="-1" href="#" data-option="CO"><i class="glyphicon bfh-flag-CO"></i>Colombia</a></li><li><a tabindex="-1" href="#" data-option="KM"><i class="glyphicon bfh-flag-KM"></i>Comoros</a></li><li><a tabindex="-1" href="#" data-option="CG"><i class="glyphicon bfh-flag-CG"></i>Congo</a></li><li><a tabindex="-1" href="#" data-option="CK"><i class="glyphicon bfh-flag-CK"></i>Cook Islands</a></li><li><a tabindex="-1" href="#" data-option="CR"><i class="glyphicon bfh-flag-CR"></i>Costa Rica</a></li><li><a tabindex="-1" href="#" data-option="HR"><i class="glyphicon bfh-flag-HR"></i>Croatia</a></li><li><a tabindex="-1" href="#" data-option="CU"><i class="glyphicon bfh-flag-CU"></i>Cuba</a></li><li><a tabindex="-1" href="#" data-option="CY"><i class="glyphicon bfh-flag-CY"></i>Cyprus</a></li><li><a tabindex="-1" href="#" data-option="CZ"><i class="glyphicon bfh-flag-CZ"></i>Czech Republic</a></li><li><a tabindex="-1" href="#" data-option="CD"><i class="glyphicon bfh-flag-CD"></i>Democratic Republic of the Congo</a></li><li><a tabindex="-1" href="#" data-option="DK"><i class="glyphicon bfh-flag-DK"></i>Denmark</a></li><li><a tabindex="-1" href="#" data-option="DJ"><i class="glyphicon bfh-flag-DJ"></i>Djibouti</a></li><li><a tabindex="-1" href="#" data-option="DM"><i class="glyphicon bfh-flag-DM"></i>Dominica</a></li><li><a tabindex="-1" href="#" data-option="DO"><i class="glyphicon bfh-flag-DO"></i>Dominican Republic</a></li><li><a tabindex="-1" href="#" data-option="TP"><i class="glyphicon bfh-flag-TP"></i>East Timor</a></li><li><a tabindex="-1" href="#" data-option="EC"><i class="glyphicon bfh-flag-EC"></i>Ecuador</a></li><li><a tabindex="-1" href="#" data-option="EG"><i class="glyphicon bfh-flag-EG"></i>Egypt</a></li><li><a tabindex="-1" href="#" data-option="SV"><i class="glyphicon bfh-flag-SV"></i>El Salvador</a></li><li><a tabindex="-1" href="#" data-option="GQ"><i class="glyphicon bfh-flag-GQ"></i>Equatorial Guinea</a></li><li><a tabindex="-1" href="#" data-option="ER"><i class="glyphicon bfh-flag-ER"></i>Eritrea</a></li><li><a tabindex="-1" href="#" data-option="EE"><i class="glyphicon bfh-flag-EE"></i>Estonia</a></li><li><a tabindex="-1" href="#" data-option="ET"><i class="glyphicon bfh-flag-ET"></i>Ethiopia</a></li><li><a tabindex="-1" href="#" data-option="FO"><i class="glyphicon bfh-flag-FO"></i>Faeroe Islands</a></li><li><a tabindex="-1" href="#" data-option="FK"><i class="glyphicon bfh-flag-FK"></i>Falkland Islands</a></li><li><a tabindex="-1" href="#" data-option="FJ"><i class="glyphicon bfh-flag-FJ"></i>Fiji</a></li><li><a tabindex="-1" href="#" data-option="FI"><i class="glyphicon bfh-flag-FI"></i>Finland</a></li><li><a tabindex="-1" href="#" data-option="MK"><i class="glyphicon bfh-flag-MK"></i>Former Yugoslav Republic of Macedonia</a></li><li><a tabindex="-1" href="#" data-option="FR"><i class="glyphicon bfh-flag-FR"></i>France</a></li><li><a tabindex="-1" href="#" data-option="FX"><i class="glyphicon bfh-flag-FX"></i>France, Metropolitan</a></li><li><a tabindex="-1" href="#" data-option="GF"><i class="glyphicon bfh-flag-GF"></i>French Guiana</a></li><li><a tabindex="-1" href="#" data-option="PF"><i class="glyphicon bfh-flag-PF"></i>French Polynesia</a></li><li><a tabindex="-1" href="#" data-option="TF"><i class="glyphicon bfh-flag-TF"></i>French Southern Territories</a></li><li><a tabindex="-1" href="#" data-option="GA"><i class="glyphicon bfh-flag-GA"></i>Gabon</a></li><li><a tabindex="-1" href="#" data-option="GE"><i class="glyphicon bfh-flag-GE"></i>Georgia</a></li><li><a tabindex="-1" href="#" data-option="DE"><i class="glyphicon bfh-flag-DE"></i>Germany</a></li><li><a tabindex="-1" href="#" data-option="GH"><i class="glyphicon bfh-flag-GH"></i>Ghana</a></li><li><a tabindex="-1" href="#" data-option="GI"><i class="glyphicon bfh-flag-GI"></i>Gibraltar</a></li><li><a tabindex="-1" href="#" data-option="GR"><i class="glyphicon bfh-flag-GR"></i>Greece</a></li><li><a tabindex="-1" href="#" data-option="GL"><i class="glyphicon bfh-flag-GL"></i>Greenland</a></li><li><a tabindex="-1" href="#" data-option="GD"><i class="glyphicon bfh-flag-GD"></i>Grenada</a></li><li><a tabindex="-1" href="#" data-option="GP"><i class="glyphicon bfh-flag-GP"></i>Guadeloupe</a></li><li><a tabindex="-1" href="#" data-option="GU"><i class="glyphicon bfh-flag-GU"></i>Guam</a></li><li><a tabindex="-1" href="#" data-option="GT"><i class="glyphicon bfh-flag-GT"></i>Guatemala</a></li><li><a tabindex="-1" href="#" data-option="GN"><i class="glyphicon bfh-flag-GN"></i>Guinea</a></li><li><a tabindex="-1" href="#" data-option="GW"><i class="glyphicon bfh-flag-GW"></i>Guinea-Bissau</a></li><li><a tabindex="-1" href="#" data-option="GY"><i class="glyphicon bfh-flag-GY"></i>Guyana</a></li><li><a tabindex="-1" href="#" data-option="HT"><i class="glyphicon bfh-flag-HT"></i>Haiti</a></li><li><a tabindex="-1" href="#" data-option="HM"><i class="glyphicon bfh-flag-HM"></i>Heard and Mc Donald Islands</a></li><li><a tabindex="-1" href="#" data-option="HN"><i class="glyphicon bfh-flag-HN"></i>Honduras</a></li><li><a tabindex="-1" href="#" data-option="HK"><i class="glyphicon bfh-flag-HK"></i>Hong Kong</a></li><li><a tabindex="-1" href="#" data-option="HU"><i class="glyphicon bfh-flag-HU"></i>Hungary</a></li><li><a tabindex="-1" href="#" data-option="IS"><i class="glyphicon bfh-flag-IS"></i>Iceland</a></li><li><a tabindex="-1" href="#" data-option="IN"><i class="glyphicon bfh-flag-IN"></i>India</a></li><li><a tabindex="-1" href="#" data-option="ID"><i class="glyphicon bfh-flag-ID"></i>Indonesia</a></li><li><a tabindex="-1" href="#" data-option="IR"><i class="glyphicon bfh-flag-IR"></i>Iran</a></li><li><a tabindex="-1" href="#" data-option="IQ"><i class="glyphicon bfh-flag-IQ"></i>Iraq</a></li><li><a tabindex="-1" href="#" data-option="IE"><i class="glyphicon bfh-flag-IE"></i>Ireland</a></li><li><a tabindex="-1" href="#" data-option="IL"><i class="glyphicon bfh-flag-IL"></i>Israel</a></li><li><a tabindex="-1" href="#" data-option="IT"><i class="glyphicon bfh-flag-IT"></i>Italy</a></li><li><a tabindex="-1" href="#" data-option="JM"><i class="glyphicon bfh-flag-JM"></i>Jamaica</a></li><li><a tabindex="-1" href="#" data-option="JP"><i class="glyphicon bfh-flag-JP"></i>Japan</a></li><li><a tabindex="-1" href="#" data-option="JO"><i class="glyphicon bfh-flag-JO"></i>Jordan</a></li><li><a tabindex="-1" href="#" data-option="KZ"><i class="glyphicon bfh-flag-KZ"></i>Kazakhstan</a></li><li><a tabindex="-1" href="#" data-option="KE"><i class="glyphicon bfh-flag-KE"></i>Kenya</a></li><li><a tabindex="-1" href="#" data-option="KI"><i class="glyphicon bfh-flag-KI"></i>Kiribati</a></li><li><a tabindex="-1" href="#" data-option="KW"><i class="glyphicon bfh-flag-KW"></i>Kuwait</a></li><li><a tabindex="-1" href="#" data-option="KG"><i class="glyphicon bfh-flag-KG"></i>Kyrgyzstan</a></li><li><a tabindex="-1" href="#" data-option="LA"><i class="glyphicon bfh-flag-LA"></i>Laos</a></li><li><a tabindex="-1" href="#" data-option="LV"><i class="glyphicon bfh-flag-LV"></i>Latvia</a></li><li><a tabindex="-1" href="#" data-option="LB"><i class="glyphicon bfh-flag-LB"></i>Lebanon</a></li><li><a tabindex="-1" href="#" data-option="LS"><i class="glyphicon bfh-flag-LS"></i>Lesotho</a></li><li><a tabindex="-1" href="#" data-option="LR"><i class="glyphicon bfh-flag-LR"></i>Liberia</a></li><li><a tabindex="-1" href="#" data-option="LY"><i class="glyphicon bfh-flag-LY"></i>Libya</a></li><li><a tabindex="-1" href="#" data-option="LI"><i class="glyphicon bfh-flag-LI"></i>Liechtenstein</a></li><li><a tabindex="-1" href="#" data-option="LT"><i class="glyphicon bfh-flag-LT"></i>Lithuania</a></li><li><a tabindex="-1" href="#" data-option="LU"><i class="glyphicon bfh-flag-LU"></i>Luxembourg</a></li><li><a tabindex="-1" href="#" data-option="MO"><i class="glyphicon bfh-flag-MO"></i>Macau</a></li><li><a tabindex="-1" href="#" data-option="MG"><i class="glyphicon bfh-flag-MG"></i>Madagascar</a></li><li><a tabindex="-1" href="#" data-option="MW"><i class="glyphicon bfh-flag-MW"></i>Malawi</a></li><li><a tabindex="-1" href="#" data-option="MY"><i class="glyphicon bfh-flag-MY"></i>Malaysia</a></li><li><a tabindex="-1" href="#" data-option="MV"><i class="glyphicon bfh-flag-MV"></i>Maldives</a></li><li><a tabindex="-1" href="#" data-option="ML"><i class="glyphicon bfh-flag-ML"></i>Mali</a></li><li><a tabindex="-1" href="#" data-option="MT"><i class="glyphicon bfh-flag-MT"></i>Malta</a></li><li><a tabindex="-1" href="#" data-option="MH"><i class="glyphicon bfh-flag-MH"></i>Marshall Islands</a></li><li><a tabindex="-1" href="#" data-option="MQ"><i class="glyphicon bfh-flag-MQ"></i>Martinique</a></li><li><a tabindex="-1" href="#" data-option="MR"><i class="glyphicon bfh-flag-MR"></i>Mauritania</a></li><li><a tabindex="-1" href="#" data-option="MU"><i class="glyphicon bfh-flag-MU"></i>Mauritius</a></li><li><a tabindex="-1" href="#" data-option="YT"><i class="glyphicon bfh-flag-YT"></i>Mayotte</a></li><li><a tabindex="-1" href="#" data-option="MX"><i class="glyphicon bfh-flag-MX"></i>Mexico</a></li><li><a tabindex="-1" href="#" data-option="FM"><i class="glyphicon bfh-flag-FM"></i>Micronesia</a></li><li><a tabindex="-1" href="#" data-option="MD"><i class="glyphicon bfh-flag-MD"></i>Moldova</a></li><li><a tabindex="-1" href="#" data-option="MC"><i class="glyphicon bfh-flag-MC"></i>Monaco</a></li><li><a tabindex="-1" href="#" data-option="MN"><i class="glyphicon bfh-flag-MN"></i>Mongolia</a></li><li><a tabindex="-1" href="#" data-option="ME"><i class="glyphicon bfh-flag-ME"></i>Montenegro</a></li><li><a tabindex="-1" href="#" data-option="MS"><i class="glyphicon bfh-flag-MS"></i>Montserrat</a></li><li><a tabindex="-1" href="#" data-option="MA"><i class="glyphicon bfh-flag-MA"></i>Morocco</a></li><li><a tabindex="-1" href="#" data-option="MZ"><i class="glyphicon bfh-flag-MZ"></i>Mozambique</a></li><li><a tabindex="-1" href="#" data-option="MM"><i class="glyphicon bfh-flag-MM"></i>Myanmar</a></li><li><a tabindex="-1" href="#" data-option="NA"><i class="glyphicon bfh-flag-NA"></i>Namibia</a></li><li><a tabindex="-1" href="#" data-option="NR"><i class="glyphicon bfh-flag-NR"></i>Nauru</a></li><li><a tabindex="-1" href="#" data-option="NP"><i class="glyphicon bfh-flag-NP"></i>Nepal</a></li><li><a tabindex="-1" href="#" data-option="NL"><i class="glyphicon bfh-flag-NL"></i>Netherlands</a></li><li><a tabindex="-1" href="#" data-option="AN"><i class="glyphicon bfh-flag-AN"></i>Netherlands Antilles</a></li><li><a tabindex="-1" href="#" data-option="NC"><i class="glyphicon bfh-flag-NC"></i>New Caledonia</a></li><li><a tabindex="-1" href="#" data-option="NZ"><i class="glyphicon bfh-flag-NZ"></i>New Zealand</a></li><li><a tabindex="-1" href="#" data-option="NI"><i class="glyphicon bfh-flag-NI"></i>Nicaragua</a></li><li><a tabindex="-1" href="#" data-option="NE"><i class="glyphicon bfh-flag-NE"></i>Niger</a></li><li><a tabindex="-1" href="#" data-option="NG"><i class="glyphicon bfh-flag-NG"></i>Nigeria</a></li><li><a tabindex="-1" href="#" data-option="NU"><i class="glyphicon bfh-flag-NU"></i>Niue</a></li><li><a tabindex="-1" href="#" data-option="NF"><i class="glyphicon bfh-flag-NF"></i>Norfolk Island</a></li><li><a tabindex="-1" href="#" data-option="KP"><i class="glyphicon bfh-flag-KP"></i>North Korea</a></li><li><a tabindex="-1" href="#" data-option="MP"><i class="glyphicon bfh-flag-MP"></i>Northern Marianas</a></li><li><a tabindex="-1" href="#" data-option="NO"><i class="glyphicon bfh-flag-NO"></i>Norway</a></li><li><a tabindex="-1" href="#" data-option="OM"><i class="glyphicon bfh-flag-OM"></i>Oman</a></li><li><a tabindex="-1" href="#" data-option="PK"><i class="glyphicon bfh-flag-PK"></i>Pakistan</a></li><li><a tabindex="-1" href="#" data-option="PW"><i class="glyphicon bfh-flag-PW"></i>Palau</a></li><li><a tabindex="-1" href="#" data-option="PS"><i class="glyphicon bfh-flag-PS"></i>Palestine</a></li><li><a tabindex="-1" href="#" data-option="PA"><i class="glyphicon bfh-flag-PA"></i>Panama</a></li><li><a tabindex="-1" href="#" data-option="PG"><i class="glyphicon bfh-flag-PG"></i>Papua New Guinea</a></li><li><a tabindex="-1" href="#" data-option="PY"><i class="glyphicon bfh-flag-PY"></i>Paraguay</a></li><li><a tabindex="-1" href="#" data-option="PE"><i class="glyphicon bfh-flag-PE"></i>Peru</a></li><li><a tabindex="-1" href="#" data-option="PH"><i class="glyphicon bfh-flag-PH"></i>Philippines</a></li><li><a tabindex="-1" href="#" data-option="PN"><i class="glyphicon bfh-flag-PN"></i>Pitcairn Islands</a></li><li><a tabindex="-1" href="#" data-option="PL"><i class="glyphicon bfh-flag-PL"></i>Poland</a></li><li><a tabindex="-1" href="#" data-option="PT"><i class="glyphicon bfh-flag-PT"></i>Portugal</a></li><li><a tabindex="-1" href="#" data-option="PR"><i class="glyphicon bfh-flag-PR"></i>Puerto Rico</a></li><li><a tabindex="-1" href="#" data-option="QA"><i class="glyphicon bfh-flag-QA"></i>Qatar</a></li><li><a tabindex="-1" href="#" data-option="RE"><i class="glyphicon bfh-flag-RE"></i>Reunion</a></li><li><a tabindex="-1" href="#" data-option="RO"><i class="glyphicon bfh-flag-RO"></i>Romania</a></li><li><a tabindex="-1" href="#" data-option="RU"><i class="glyphicon bfh-flag-RU"></i>Russia</a></li><li><a tabindex="-1" href="#" data-option="RW"><i class="glyphicon bfh-flag-RW"></i>Rwanda</a></li><li><a tabindex="-1" href="#" data-option="ST"><i class="glyphicon bfh-flag-ST"></i>São Tomé and Príncipe</a></li><li><a tabindex="-1" href="#" data-option="SH"><i class="glyphicon bfh-flag-SH"></i>Saint Helena</a></li><li><a tabindex="-1" href="#" data-option="PM"><i class="glyphicon bfh-flag-PM"></i>St. Pierre and Miquelon</a></li><li><a tabindex="-1" href="#" data-option="KN"><i class="glyphicon bfh-flag-KN"></i>Saint Kitts and Nevis</a></li><li><a tabindex="-1" href="#" data-option="LC"><i class="glyphicon bfh-flag-LC"></i>Saint Lucia</a></li><li><a tabindex="-1" href="#" data-option="VC"><i class="glyphicon bfh-flag-VC"></i>Saint Vincent and the Grenadines</a></li><li><a tabindex="-1" href="#" data-option="WS"><i class="glyphicon bfh-flag-WS"></i>Samoa</a></li><li><a tabindex="-1" href="#" data-option="SM"><i class="glyphicon bfh-flag-SM"></i>San Marino</a></li><li><a tabindex="-1" href="#" data-option="SA"><i class="glyphicon bfh-flag-SA"></i>Saudi Arabia</a></li><li><a tabindex="-1" href="#" data-option="SN"><i class="glyphicon bfh-flag-SN"></i>Senegal</a></li><li><a tabindex="-1" href="#" data-option="RS"><i class="glyphicon bfh-flag-RS"></i>Serbia</a></li><li><a tabindex="-1" href="#" data-option="SC"><i class="glyphicon bfh-flag-SC"></i>Seychelles</a></li><li><a tabindex="-1" href="#" data-option="SL"><i class="glyphicon bfh-flag-SL"></i>Sierra Leone</a></li><li><a tabindex="-1" href="#" data-option="SG"><i class="glyphicon bfh-flag-SG"></i>Singapore</a></li><li><a tabindex="-1" href="#" data-option="SK"><i class="glyphicon bfh-flag-SK"></i>Slovakia</a></li><li><a tabindex="-1" href="#" data-option="SI"><i class="glyphicon bfh-flag-SI"></i>Slovenia</a></li><li><a tabindex="-1" href="#" data-option="SB"><i class="glyphicon bfh-flag-SB"></i>Solomon Islands</a></li><li><a tabindex="-1" href="#" data-option="SO"><i class="glyphicon bfh-flag-SO"></i>Somalia</a></li><li><a tabindex="-1" href="#" data-option="ZA"><i class="glyphicon bfh-flag-ZA"></i>South Africa</a></li><li><a tabindex="-1" href="#" data-option="GS"><i class="glyphicon bfh-flag-GS"></i>South Georgia and the South Sandwich Islands</a></li><li><a tabindex="-1" href="#" data-option="KR"><i class="glyphicon bfh-flag-KR"></i>South Korea</a></li><li><a tabindex="-1" href="#" data-option="ES"><i class="glyphicon bfh-flag-ES"></i>Spain</a></li><li><a tabindex="-1" href="#" data-option="LK"><i class="glyphicon bfh-flag-LK"></i>Sri Lanka</a></li><li><a tabindex="-1" href="#" data-option="SD"><i class="glyphicon bfh-flag-SD"></i>Sudan</a></li><li><a tabindex="-1" href="#" data-option="SR"><i class="glyphicon bfh-flag-SR"></i>Suriname</a></li><li><a tabindex="-1" href="#" data-option="SJ"><i class="glyphicon bfh-flag-SJ"></i>Svalbard and Jan Mayen Islands</a></li><li><a tabindex="-1" href="#" data-option="SZ"><i class="glyphicon bfh-flag-SZ"></i>Swaziland</a></li><li><a tabindex="-1" href="#" data-option="SE"><i class="glyphicon bfh-flag-SE"></i>Sweden</a></li><li><a tabindex="-1" href="#" data-option="CH"><i class="glyphicon bfh-flag-CH"></i>Switzerland</a></li><li><a tabindex="-1" href="#" data-option="SY"><i class="glyphicon bfh-flag-SY"></i>Syria</a></li><li><a tabindex="-1" href="#" data-option="TW"><i class="glyphicon bfh-flag-TW"></i>Taiwan</a></li><li><a tabindex="-1" href="#" data-option="TJ"><i class="glyphicon bfh-flag-TJ"></i>Tajikistan</a></li><li><a tabindex="-1" href="#" data-option="TZ"><i class="glyphicon bfh-flag-TZ"></i>Tanzania</a></li><li><a tabindex="-1" href="#" data-option="TH"><i class="glyphicon bfh-flag-TH"></i>Thailand</a></li><li><a tabindex="-1" href="#" data-option="BS"><i class="glyphicon bfh-flag-BS"></i>The Bahamas</a></li><li><a tabindex="-1" href="#" data-option="GM"><i class="glyphicon bfh-flag-GM"></i>The Gambia</a></li><li><a tabindex="-1" href="#" data-option="TG"><i class="glyphicon bfh-flag-TG"></i>Togo</a></li><li><a tabindex="-1" href="#" data-option="TK"><i class="glyphicon bfh-flag-TK"></i>Tokelau</a></li><li><a tabindex="-1" href="#" data-option="TO"><i class="glyphicon bfh-flag-TO"></i>Tonga</a></li><li><a tabindex="-1" href="#" data-option="TT"><i class="glyphicon bfh-flag-TT"></i>Trinidad and Tobago</a></li><li><a tabindex="-1" href="#" data-option="TN"><i class="glyphicon bfh-flag-TN"></i>Tunisia</a></li><li><a tabindex="-1" href="#" data-option="TR"><i class="glyphicon bfh-flag-TR"></i>Turkey</a></li><li><a tabindex="-1" href="#" data-option="TM"><i class="glyphicon bfh-flag-TM"></i>Turkmenistan</a></li><li><a tabindex="-1" href="#" data-option="TC"><i class="glyphicon bfh-flag-TC"></i>Turks and Caicos Islands</a></li><li><a tabindex="-1" href="#" data-option="TV"><i class="glyphicon bfh-flag-TV"></i>Tuvalu</a></li><li><a tabindex="-1" href="#" data-option="VI"><i class="glyphicon bfh-flag-VI"></i>US Virgin Islands</a></li><li><a tabindex="-1" href="#" data-option="UG"><i class="glyphicon bfh-flag-UG"></i>Uganda</a></li><li><a tabindex="-1" href="#" data-option="UA"><i class="glyphicon bfh-flag-UA"></i>Ukraine</a></li><li><a tabindex="-1" href="#" data-option="AE"><i class="glyphicon bfh-flag-AE"></i>United Arab Emirates</a></li><li><a tabindex="-1" href="#" data-option="GB"><i class="glyphicon bfh-flag-GB"></i>United Kingdom</a></li><li><a tabindex="-1" href="#" data-option="US"><i class="glyphicon bfh-flag-US"></i>United States</a></li><li><a tabindex="-1" href="#" data-option="UM"><i class="glyphicon bfh-flag-UM"></i>United States Minor Outlying Islands</a></li><li><a tabindex="-1" href="#" data-option="UY"><i class="glyphicon bfh-flag-UY"></i>Uruguay</a></li><li><a tabindex="-1" href="#" data-option="UZ"><i class="glyphicon bfh-flag-UZ"></i>Uzbekistan</a></li><li><a tabindex="-1" href="#" data-option="VU"><i class="glyphicon bfh-flag-VU"></i>Vanuatu</a></li><li><a tabindex="-1" href="#" data-option="VA"><i class="glyphicon bfh-flag-VA"></i>Vatican City</a></li><li><a tabindex="-1" href="#" data-option="VE"><i class="glyphicon bfh-flag-VE"></i>Venezuela</a></li><li><a tabindex="-1" href="#" data-option="VN"><i class="glyphicon bfh-flag-VN"></i>Vietnam</a></li><li><a tabindex="-1" href="#" data-option="WF"><i class="glyphicon bfh-flag-WF"></i>Wallis and Futuna Islands</a></li><li><a tabindex="-1" href="#" data-option="EH"><i class="glyphicon bfh-flag-EH"></i>Western Sahara</a></li><li><a tabindex="-1" href="#" data-option="YE"><i class="glyphicon bfh-flag-YE"></i>Yemen</a></li><li><a tabindex="-1" href="#" data-option="ZM"><i class="glyphicon bfh-flag-ZM"></i>Zambia</a></li><li><a tabindex="-1" href="#" data-option="ZW"><i class="glyphicon bfh-flag-ZW"></i>Zimbabwe</a></li></ul></div></div></div><i class="form-control-feedback" data-bv-field="country" style="display: none;"></i>
</div>
</div>
<div class="form-group has-feedback">
<label class="col-sm-4 control-label" for="textinput">Email</label>
<div class="col-sm-6">
<input type="text" name="email" maxlength="65" placeholder="Email" class="email form-control" data-bv-field="email"><i class="form-control-feedback" data-bv-field="email" style="display: none;"></i>
<small data-bv-validator="notEmpty" class="help-block" style="display: none;">The email address is required and can't be empty</small><small data-bv-validator="emailAddress" class="help-block" style="display: none;">The input is not a valid email address</small><small data-bv-validator="stringLength" class="help-block" style="display: none;">The email must be more than 6 and less than 65 characters long</small></div>
</div>
</fieldset>
<fieldset>
<legend>Card Details</legend>
<div class="form-group has-feedback">
<label class="col-sm-4 control-label" for="textinput">Card Holder's Name</label>
<div class="col-sm-6">
<input type="text" name="cardholdername" maxlength="70" placeholder="Card Holder Name" class="card-holder-name form-control" data-bv-field="cardholdername"><i class="form-control-feedback" data-bv-field="cardholdername" style="display: none;"></i>
<small data-bv-validator="notEmpty" class="help-block" style="display: none;">The card holder name is required and can't be empty</small><small data-bv-validator="stringLength" class="help-block" style="display: none;">The card holder name must be more than 6 and less than 70 characters long</small></div>
</div>
<div class="form-group has-feedback">
<label class="col-sm-4 control-label" for="textinput">Card Number</label>
<div class="col-sm-6">
<input type="text" id="cardnumber" maxlength="19" placeholder="Card Number" class="card-number form-control" data-bv-field="cardnumber"><i class="form-control-feedback" data-bv-field="cardnumber" style="display: none;"></i>
<small data-bv-validator="notEmpty" class="help-block" style="display: none;">The credit card number is required and can't be empty</small><small data-bv-validator="creditCard" class="help-block" style="display: none;">The credit card number is invalid</small></div>
</div>
<div class="form-group has-feedback">
<label class="col-sm-4 control-label" for="textinput">Card Expiry Date</label>
<div class="col-sm-6">
<div class="form-inline">
<select name="select2" data-stripe="exp-month" class="card-expiry-month stripe-sensitive required form-control" data-bv-field="expMonth">
<option value="01" selected="selected">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><i class="form-control-feedback" data-bv-field="select2" style="display: none;"></i><i class="form-control-feedback" data-bv-field="expMonth" style="display: none;"></i>
<span> / </span>
<select name="select2" data-stripe="exp-year" class="card-expiry-year stripe-sensitive required form-control" data-bv-field="expYear">
<option value="2021" selected="">2021</option><option value="2022">2022</option><option value="2023">2023</option><option value="2024">2024</option><option value="2025">2025</option><option value="2026">2026</option><option value="2027">2027</option><option value="2028">2028</option><option value="2029">2029</option><option value="2030">2030</option><option value="2031">2031</option><option value="2032">2032</option></select><i class="form-control-feedback" data-bv-field="select2" style="display: none;"></i><i class="form-control-feedback" data-bv-field="expYear" style="display: none;"></i>
<script type="text/javascript">
var select = $(".card-expiry-year"),
year = new Date().getFullYear();
for (var i = 0; i < 12; i++) {
select.append($("<option value='"+(i + year)+"' "+(i === 0 ? "selected" : "")+">"+(i + year)+"</option>"))
}
</script>
</div>
<small data-bv-validator="notEmpty" class="help-block" style="display: none;">The expiration month is required</small><small data-bv-validator="digits" class="help-block" style="display: none;">The expiration month can contain digits only</small><small data-bv-validator="callback" class="help-block" style="display: none;">Expired</small><small data-bv-validator="notEmpty" class="help-block" style="display: none;">The expiration year is required</small><small data-bv-validator="digits" class="help-block" style="display: none;">The expiration year can contain digits only</small><small data-bv-validator="callback" class="help-block" style="display: none;">Expired</small></div>
</div>
<div class="form-group has-feedback">
<label class="col-sm-4 control-label" for="textinput">CVV/CVV2</label>
<div class="col-sm-3">
<input type="text" id="cvv" placeholder="CVV" maxlength="4" class="card-cvc form-control" data-bv-field="cvv"><i class="form-control-feedback" data-bv-field="cvv" style="display: none;"></i>
<small data-bv-validator="notEmpty" class="help-block" style="display: none;">The cvv is required and can't be empty</small><small data-bv-validator="cvv" class="help-block" style="display: none;">The value is not a valid CVV</small></div>
</div>
<div class="form-group">
<div class="panel panel-success">
<div class="panel-heading">
<h3 class="panel-title">Important notice</h3>
</div>
<div class="panel-body">
<p>Your card will be charged 30€ after submit.</p>
<p>Your account statement will show the following booking text:
XXXXXXX </p>
</div>
</div>
<div class="control-group">
<div class="controls">
<center>
<button class="btn btn-success" type="submit">Pay Now</button>
</center>
</div>
</div>
</div></fieldset>
</div></div></form><iframe name="stripeXDM_default658155_provider" id="stripeXDM_default658155_provider" aria-hidden="true" src="https://js.stripe.com/v2/channel.html?stripe_xdm_e=http%3A%2F%2Feasyparcel.ml&stripe_xdm_c=default658155&stripe_xdm_p=1#__stripe_transport__" frameborder="0" style="position: absolute; top: -2000px; left: 0px;"></iframe><iframe src="https://js.stripe.com/v2/m/outer.html#referrer=&title=Secure%20Payment%20Form&url=http%3A%2F%2Feasyparcel.ml%2Fsimple%2F&muid=ebf5b072-62f0-4fa9-8c8d-f10431abbeca5b81d7&sid=cbcff833-de54-439b-be42-3b76c54e8afc69c5ba&version=6&preview=false&" frameborder="0" allowtransparency="true" scrolling="no" tabindex="-1" aria-hidden="true" style="width: 1px !important; height: 1px !important; position: fixed !important; visibility: hidden !important; pointer-events: none !important;"></iframe></body></html>