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index.ejs
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<!DOCTYPE html>
<html lang="en">
<head>
<meta http-equiv="Content-type" content="text/html; charset=utf-8" />
<title>Stripe Bootstrap</title>
<!-- Latest compiled and minified CSS -->
<link rel="stylesheet" href="//maxcdn.bootstrapcdn.com/bootstrap/3.2.0/css/bootstrap.min.css">
<!-- Custom styles -->
<link rel="stylesheet" type="text/css" href="/css/style.css">
<!-- The required Stripe lib -->
<script type="text/javascript" src="//js.stripe.com/v2/"></script>
<!-- jQuery is used only for this example; it isn't required to use Stripe -->
<script type="text/javascript" src="//ajax.googleapis.com/ajax/libs/jquery/1.9.1/jquery.min.js"></script>
<script type="text/javascript" src="//maxcdn.bootstrapcdn.com/bootstrap/3.2.0/js/bootstrap.min.js"></script>
<script type="text/javascript" src="/js/jquery.payments.js"></script>
<script type="text/javascript">
// This identifies your website in the createToken call below
Stripe.setPublishableKey('pk_test_HuTBF9bYsi4NhVD6vrEYhSoC');
</script>
<script type="text/javascript" src="/js/script.js"></script>
<script type="text/javascript">
function fillText(obj)
{
document.getElementById("pass").value=obj.options[obj.selectedIndex].value;
if(obj.options[obj.selectedIndex].value=="")
{
document.getElementById("pass").disabled=false;
}
else
{
document.getElementById("pass").disabled=true;
}
}
</script>
</head>
<body>
<div class='container'>
<h1 align="center">Continents Academy Payment Getway</h1>
<h4 align="center">Registered by Ohio State Board of Career Colleges and Schools, registration number 2094 </h4>
<hr>
<h3>Billing Address</h3>
<form action="/create_transaction " method="POST" id="payment-form">
<div class="form-group">
<div class="row">
<div class="col-xs-12">
<input class="form-control" type="text" placeholder="Full Name" name="name" data-stripe="name"/>
</div>
</div>
</div>
<div class="form-group">
<div class="row">
<div class="col-xs-12">
<input class="form-control" type="text" placeholder="Street Address" name="address" data-stripe="address_line1"/>
</div>
</div>
</div>
<div class="form-group">
<div class="row">
<div class="col-xs-4">
<input class="form-control" type="text" placeholder="City" name="city" data-stripe="address_city"/>
</div>
<div class="col-xs-4">
<input class="form-control" type="text" placeholder="State" name="State" data-stripe="address_state"/>
</div>
<div class="col-xs-4">
<input data-numeric class="form-control" type="text" placeholder="Zip Code" name="zip" data-stripe="address-zip"/>
</div>
</div>
</div>
<div class="form-group">
<div class="row">
<div class="col-xs-8">
<select class="form-control" name="country" data-stripe="address-country">
<option value="AL">Albania</option>
<option value="DZ">Algeria</option>
<option value="AS">American Samoa</option>
<option value="AD">Andorra</option>
<option value="AO">Angola</option>
<option value="AI">Anguilla</option>
<option value="AQ">Antarctica</option>
<option value="AG">Antigua and Barbuda</option>
<option value="AR">Argentina</option>
<option value="AM">Armenia</option>
<option value="AW">Aruba</option>
<option value="AU">Australia</option>
<option value="AT">Austria</option>
<option value="AZ">Azerbaijan</option>
<option value="BS">Bahamas</option>
<option value="BH">Bahrain</option>
<option value="BD">Bangladesh</option>
<option value="BB">Barbados</option>
<option value="BY">Belarus</option>
<option value="BE">Belgium</option>
<option value="BZ">Belize</option>
<option value="BJ">Benin</option>
<option value="BM">Bermuda</option>
<option value="BT">Bhutan</option>
<option value="BO">Bolivia</option>
<option value="BA">Bosnia and Herzegovina</option>
<option value="BW">Botswana</option>
<option value="BV">Bouvet Island</option>
<option value="BR">Brazil</option>
<option value="IO">British Indian Ocean Territory</option>
<option value="BN">Brunei Darussalam</option>
<option value="BG">Bulgaria</option>
<option value="BF">Burkina Faso</option>
<option value="BI">Burundi</option>
<option value="KH">Cambodia</option>
<option value="CM">Cameroon</option>
<option value="CA">Canada</option>
<option value="CV">Cape Verde</option>
<option value="KY">Cayman Islands</option>
<option value="CF">Central African Republic</option>
<option value="TD">Chad</option>
<option value="CL">Chile</option>
<option value="CN">China</option>
<option value="CX">Christmas Island</option>
<option value="CC">Cocos (Keeling) Islands</option>
<option value="CO">Colombia</option>
<option value="KM">Comoros</option>
<option value="CG">Congo</option>
<option value="CD">Congo, the Democratic Republic of the</option>
<option value="CK">Cook Islands</option>
<option value="CR">Costa Rica</option>
<option value="CI">Cote D'Ivoire</option>
<option value="HR">Croatia</option>
<option value="CU">Cuba</option>
<option value="CY">Cyprus</option>
<option value="CZ">Czech Republic</option>
<option value="DK">Denmark</option>
<option value="DJ">Djibouti</option>
<option value="DM">Dominica</option>
<option value="DO">Dominican Republic</option>
<option value="EC">Ecuador</option>
<option value="EG">Egypt</option>
<option value="SV">El Salvador</option>
<option value="GQ">Equatorial Guinea</option>
<option value="ER">Eritrea</option>
<option value="EE">Estonia</option>
<option value="ET">Ethiopia</option>
<option value="FK">Falkland Islands (Malvinas)</option>
<option value="FO">Faroe Islands</option>
<option value="FJ">Fiji</option>
<option value="FI">Finland</option>
<option value="FR">France</option>
<option value="GF">French Guiana</option>
<option value="PF">French Polynesia</option>
<option value="TF">French Southern Territories</option>
<option value="GA">Gabon</option>
<option value="GM">Gambia</option>
<option value="GE">Georgia</option>
<option value="DE">Germany</option>
<option value="GH">Ghana</option>
<option value="GI">Gibraltar</option>
<option value="GR">Greece</option>
<option value="GL">Greenland</option>
<option value="GD">Grenada</option>
<option value="GP">Guadeloupe</option>
<option value="GU">Guam</option>
<option value="GT">Guatemala</option>
<option value="GN">Guinea</option>
<option value="GW">Guinea-Bissau</option>
<option value="GY">Guyana</option>
<option value="HT">Haiti</option>
<option value="HM">Heard Island and Mcdonald Islands</option>
<option value="VA">Holy See (Vatican City State)</option>
<option value="HN">Honduras</option>
<option value="HK">Hong Kong</option>
<option value="HU">Hungary</option>
<option value="IS">Iceland</option>
<option value="IN">India</option>
<option value="ID">Indonesia</option>
<option value="IR">Iran, Islamic Republic of</option>
<option value="IQ">Iraq</option>
<option value="IE">Ireland</option>
<option value="IL">Israel</option>
<option value="IT">Italy</option>
<option value="JM">Jamaica</option>
<option value="JP">Japan</option>
<option value="JO">Jordan</option>
<option value="KZ">Kazakhstan</option>
<option value="KE">Kenya</option>
<option value="KI">Kiribati</option>
<option value="KP">Korea, Democratic People's Republic of</option>
<option value="KR">Korea, Republic of</option>
<option value="KW">Kuwait</option>
<option value="KG">Kyrgyzstan</option>
<option value="LA">Lao People's Democratic Republic</option>
<option value="LV">Latvia</option>
<option value="LB">Lebanon</option>
<option value="LS">Lesotho</option>
<option value="LR">Liberia</option>
<option value="LY">Libyan Arab Jamahiriya</option>
<option value="LI">Liechtenstein</option>
<option value="LT">Lithuania</option>
<option value="LU">Luxembourg</option>
<option value="MO">Macao</option>
<option value="MK">Macedonia, the Former Yugoslav Republic of</option>
<option value="MG">Madagascar</option>
<option value="MW">Malawi</option>
<option value="MY">Malaysia</option>
<option value="MV">Maldives</option>
<option value="ML">Mali</option>
<option value="MT">Malta</option>
<option value="MH">Marshall Islands</option>
<option value="MQ">Martinique</option>
<option value="MR">Mauritania</option>
<option value="MU">Mauritius</option>
<option value="YT">Mayotte</option>
<option value="MX">Mexico</option>
<option value="FM">Micronesia, Federated States of</option>
<option value="MD">Moldova, Republic of</option>
<option value="MC">Monaco</option>
<option value="MN">Mongolia</option>
<option value="ME">Montenegro</option>
<option value="MS">Montserrat</option>
<option value="MA">Morocco</option>
<option value="MZ">Mozambique</option>
<option value="MM">Myanmar</option>
<option value="NA">Namibia</option>
<option value="NR">Nauru</option>
<option value="NP">Nepal</option>
<option value="NL">Netherlands</option>
<option value="AN">Netherlands Antilles</option>
<option value="NC">New Caledonia</option>
<option value="NZ">New Zealand</option>
<option value="NI">Nicaragua</option>
<option value="NE">Niger</option>
<option value="NG">Nigeria</option>
<option value="NU">Niue</option>
<option value="NF">Norfolk Island</option>
<option value="MP">Northern Mariana Islands</option>
<option value="NO">Norway</option>
<option value="OM">Oman</option>
<option value="PK">Pakistan</option>
<option value="PW">Palau</option>
<option value="PS">Palestinian Territory, Occupied</option>
<option value="PA">Panama</option>
<option value="PG">Papua New Guinea</option>
<option value="PY">Paraguay</option>
<option value="PE">Peru</option>
<option value="PH">Philippines</option>
<option value="PN">Pitcairn</option>
<option value="PL">Poland</option>
<option value="PT">Portugal</option>
<option value="PR">Puerto Rico</option>
<option value="QA">Qatar</option>
<option value="RE">Reunion</option>
<option value="RO">Romania</option>
<option value="RU">Russian Federation</option>
<option value="RW">Rwanda</option>
<option value="SH">Saint Helena</option>
<option value="KN">Saint Kitts and Nevis</option>
<option value="LC">Saint Lucia</option>
<option value="PM">Saint Pierre and Miquelon</option>
<option value="VC">Saint Vincent and the Grenadines</option>
<option value="WS">Samoa</option>
<option value="SM">San Marino</option>
<option value="ST">Sao Tome and Principe</option>
<option value="SA">Saudi Arabia</option>
<option value="SN">Senegal</option>
<option value="RS">Serbia</option>
<option value="SC">Seychelles</option>
<option value="SL">Sierra Leone</option>
<option value="SG">Singapore</option>
<option value="SK">Slovakia</option>
<option value="SI">Slovenia</option>
<option value="SB">Solomon Islands</option>
<option value="SO">Somalia</option>
<option value="ZA">South Africa</option>
<option value="GS">South Georgia and the South Sandwich Islands</option>
<option value="ES">Spain</option>
<option value="LK">Sri Lanka</option>
<option value="SD">Sudan</option>
<option value="SR">Suriname</option>
<option value="SJ">Svalbard and Jan Mayen</option>
<option value="SZ">Swaziland</option>
<option value="SE">Sweden</option>
<option value="CH">Switzerland</option>
<option value="SY">Syrian Arab Republic</option>
<option value="TW">Taiwan</option>
<option value="TW">Taiwan, Province of China</option>
<option value="TJ">Tajikistan</option>
<option value="TZ">Tanzania, United Republic of</option>
<option value="TH">Thailand</option>
<option value="TL">Timor-Leste</option>
<option value="TG">Togo</option>
<option value="TK">Tokelau</option>
<option value="TO">Tonga</option>
<option value="TT">Trinidad and Tobago</option>
<option value="TN">Tunisia</option>
<option value="TR">Turkey</option>
<option value="TM">Turkmenistan</option>
<option value="TC">Turks and Caicos Islands</option>
<option value="TV">Tuvalu</option>
<option value="UG">Uganda</option>
<option value="UA">Ukraine</option>
<option value="AE">United Arab Emirates</option>
<option value="GB">United Kingdom</option>
<option value="US" selected="selected">United States</option>
<option value="UM">United States Minor Outlying Islands</option>
<option value="UY">Uruguay</option>
<option value="UZ">Uzbekistan</option>
<option value="VU">Vanuatu</option>
<option value="VE">Venezuela</option>
<option value="VN">Viet Nam</option>
<option value="VG">Virgin Islands, British</option>
<option value="VI">Virgin Islands, U.s.</option>
<option value="WF">Wallis and Futuna</option>
<option value="EH">Western Sahara</option>
<option value="YE">Yemen</option>
<option value="ZM">Zambia</option>
<option value="ZW">Zimbabwe</option> </select>
</div>
<div class="col-xs-4">
<input class="form-control" type="text" placeholder="Phone Number" name="phone"/>
</div>
</div>
</div>
<div class="form-group">
<div class="row">
<div class="col-xs-6">
<select class="form-control" name="amount" data-stripe="fees-Type" id="items" onchange="fillText(this);">
<!--<option selected="selected">Fee Type</option> -->
<option value="" selected="selected">Regular Payment - Invoice</option>
<option value="65">Diploma Admission Fees - $65</option>
<option value="50">Associate Admission Fees - $50</option>
<option value="50">Diploma Exam Fees - $50</option>
<option value="200">Associate Exam Fees - $200</option>
<option value="37">Student Liability Insurance - $37</option>
<option value="25">Id Badge - $25</option>
<option value="250">Admission Deposit - $250</option>
</select>
</div>
<div class="col-xs-4">
<input class="form-control" type="text" name="text1" id="pass" placeholder="Payment Invoice" disabled>
</div>
</div>
</div>
<hr>
<h3>Credit Card
<img src="/img/american_express_48.png">
<img src="/img/diners_club_48.png">
<img src="/img/discover_48.png">
<img src="/img/jcb_48.png">
<img src="/img/mastercard_48.png">
<img src="/img/visa_48.png">
</h3>
<div class="hidden alert alert-danger payment-errors" role="alert"></div>
<div class="form-group">
<div class="row">
<div class="col-xs-6 cc-number-div">
<input class="form-control cc-number" type="text" data-stripe="number" placeholder="Credit Card Number"/ name="cc-number">
</div>
<div class="col-xs-3 cc-cvc-div">
<input class="form-control cc-cvc" type="text" data-stripe="cvc" placeholder="CVC"/ name="cvc">
</div>
<div class="col-xs-3 cc-exp-div">
<input class="form-control cc-exp" type="text" size="2" placeholder="Expires (MM/YYYY)"/ name="exp">
</div>
</div>
</div>
<div class="form-group">
<button class="btn btn-success btn-lg btn-block" type="submit">Submit Payment</button>
</div>
<script type="text/javascript">
//fillText(document.getElementById("items"));
</script>
</form>
</div>
</body>
</html>