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<!DOCTYPE HTML> <html> <head> <title>User Purchase Recurring | Miricam</title> <meta charset="utf-8" /> <meta http-equiv="window-target" content="_top"> <meta name="viewport" content="width=device-width, initial-scale=1"/> <meta http-equiv="Cache-Control" content="no-cache, no-store, must-revalidate" /> <meta http-equiv="Pragma" content="no-cache" /> <meta http-equiv="Expires" content="0" /> <link rel="shortcut icon" href="images/favicon.ico" type="image/x-icon" /> <link rel="stylesheet" href="css/bootstrap.min.css" /> <link rel="stylesheet" href="css/gijgo.min.css" /> <link rel="stylesheet" href="css/style.css" /> </head> <body class="landing" onload=""> <div id="page-wrapper"> <header id="header" class="alt"> <div class="col-md-2"> <a href="index.html" style="border:0;" class="logoImg"> <img src="images/mLogo.png" alt="" border="0"> </a> </div> <div class="col-md-10"> <nav id="nav"> <ul> <li><a href="user-dashboard.html">Dashboard</a></li> <li><a href="performers-list.html">Performers List</a></li> <li><a href="javascript:void(0);" onclick="logout()">Logout</a></li> <li id="customertotalamount_li"><a href="javascript:void(0);">Account Balance : $<span id="customerTotalAmount"></span></a></li> </ul> </nav> </div> </header> <!-- Main --> <section id="main" class="container-fluid mainbodypanel"> <section class="box special"> <div class="row"> <div class="col-xs-12"> <div class="marginTop"> <div class="panel panel-default"> <div class="panel-body"> <h1>Make A Payment</h1> <p>Please complete the form below. Your payment will be handled via my trusted payment processor, Netbilling.</p> <form method="post" action="https://secure.netbilling.com/gw/native/interactive2.2" name="customerPurchaseTimeForm" id="customerPurchaseTimeForm"> <div class="form-horizontal signUpFrm"> <div class="form-group col-md-6"> <label class="col-md-4 control-label" for="firstName">First Name</label> <div class="col-md-8"> <input id="firstName" name="Ecom_BillTo_Postal_Name_First" type="text" placeholder="First Name" class="form-control" maxlength="50"> </div> </div> <div class="form-group col-md-6"> <label class="col-md-4 control-label" for="lastName">Last Name</label> <div class="col-md-8"> <input id="lastName" name="Ecom_BillTo_Postal_Name_Last" type="text" placeholder="Last Name" class="form-control" maxlength="50"> </div> </div> <div class="form-group col-md-6"> <label class="col-md-4 control-label" for="email">Email</label> <div class="col-md-8"> <input id="email" name="Ecom_BillTo_Online_Email" type="email" placeholder="Email" class="form-control" maxlength="100"> </div> </div> <div class="form-group col-md-6"> <label class="col-md-4 control-label" for="street">Street Address</label> <div class="col-md-8"> <input id="street" name="Ecom_BillTo_Postal_Street_Line1" type="text" placeholder="Street Address" class="form-control" maxlength="150"> </div> </div> <div class="form-group col-md-6"> <label class="col-md-4 control-label" for="city">City</label> <div class="col-md-8"> <input id="city" name="Ecom_BillTo_Postal_City" type="text" placeholder="City" class="form-control" maxlength="50"> </div> </div> <div class="form-group col-md-6"> <label class="col-md-4 control-label" for="state">State / Province</label> <div class="col-md-8"> <select id="state" name="Ecom_BillTo_Postal_StateProv" class="form-control"> <option value="">Select State</option> </select> </div> </div> <div class="clearfix"></div> <div class="form-group col-md-6"> <label class="col-md-4 control-label" for="country">Country</label> <div class="col-md-8"> <select id="country" name="Ecom_BillTo_Postal_CountryCode" class="form-control" onchange="getStatesList(this);"> <option value="">Select Country</option> </select> </div> </div> <div class="form-group col-md-6"> <label class="col-md-4 control-label" for="zip">Zipcode</label> <div class="col-md-8"> <input id="zip" name="Ecom_BillTo_Postal_PostalCode" type="text" placeholder="Zipcode" class="form-control" maxlength="8"> </div> </div> <div class="form-group col-md-6"> <label class="col-md-4 control-label" for="cardNumber">Card Number</label> <div class="col-md-8"> <input id="cardNumber" name="Ecom_Payment_Card_Number" type="text" placeholder="Card Number" class="form-control" maxlength="20" autocomplete='off'> </div> </div> <div class="form-group col-md-6"> <label class="col-md-4 control-label" for="cardMonth">Month</label> <div class="col-md-8"> <select id="cardMonth" name="Ecom_Payment_Card_ExpDate_Month" class="form-control"> <option value="">Select 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="clearfix"></div> <div class="form-group col-md-6"> <label class="col-md-4 control-label" for="cardYear">Year</label> <div class="col-md-8"> <select id="cardYear" name="Ecom_Payment_Card_ExpDate_Year" class="form-control"> <option value="">Select Year</option> <option value="2018">2018</option> <option value="2019">2019</option> <option value="2020">2020</option> <option value="2021">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> <option value="2033">2033</option> <option value="2034">2034</option> <option value="2035">2035</option> </select> </div> </div> <div class="form-group col-md-6"> <label class="col-md-4 control-label" for="cardCVV">CVV2 3-Digit Security Code</label> <div class="col-md-8"> <input id="cardCVV" name="Ecom_Ezic_Response_Card_VerificationCode" type="text" placeholder="CVV2 3-Digit Security Code" class="form-control" maxlength="3" autocomplete='off'> </div> </div> <div class="form-group col-md-6"> <label class="col-md-4 control-label" for="cardAmount">Amount</label> <div class="col-md-8"> <!-- Ecom_Cost_Total --> <input id="cardAmount" name="Ecom_Ezic_Recurring_Amount" type="text" placeholder="Amount" class="form-control" maxlength="8" autocomplete='off'> </div> </div> <div class="form-group col-md-6"> <label class="col-md-4 control-label" for="rememberCardDetails">Remember Card Details?</label> <div class="col-md-2"> <input class="form-control" name="rememberCardDetails" id="rememberCardDetails" type="checkbox" value="1" onclick="rememberCardInfo()"> </div> </div> </div> <!--hidden variables for payment--> <input type=hidden value=1 name=Ezic_HideForm> <input type=hidden value="" name=Ecom_Ezic_Fulfillment_ReturnURL id=netBillReturnURL> <!-- Live account details --> <!--<input type=hidden value=111259917650:MIRICAM name=Ecom_Ezic_AccountAndSitetag> <input type=hidden value=113899291807 name=Ecom_Ezic_PaymentFormId> --> <!-- Local account details --> <input type=hidden value=104901072025:HIDDEN name=Ecom_Ezic_AccountAndSitetag> <input type=hidden value=110252206856 name=Ecom_Ezic_PaymentFormId> <input type=hidden value=SALE name=Ecom_Ezic_Payment_AuthorizationType> <input type=hidden value=GET name=Ecom_Ezic_Fulfillment_ReturnMethod> <input type=hidden value=123abc456 name=Ecom_UserData_PerformerUniqueId id=Ecom_UserData_PerformerUniqueId> <input type=hidden value=456abc13 name=Ecom_UserData_CustomerUniqueId> <input type=hidden value="" name=Ecom_UserData_CardNumber id=Ecom_UserData_CardNumber> <!-- variable for recurring payment --> <input type="hidden" name="Ecom_Ezic_Membership_Period" value="30.00000" /> <input type="hidden" name="Ecom_Ezic_Recurring_Period" value="30" /> <input type="hidden" name="Ecom_Ezic_Recurring_Count" value="" /> <div class="col-md-12 align-center"> <br/><br/> <button type="submit" class="btn btn-sm btn-default btnNewSign" onclick="getCardNumber()">Make Payment</button> </div> </form> <div class="col-md-12 align-center"> <img src = "images/paymentformbc.gif"><br/><br/> <p>Questions or problems? Please <a href="http://www.2much.net/contact.php" target="_blank">Contact Us</a></p> </div> </div> </div> </div> </div> </div> </section> </section> <!-- Footer --> <footer id="footer" class="container-fluid"> <section class="box special"> <img src="images/secure-netbilling.gif" alt="Secure NETBilling Image"/> <p> <font size="4"><a href="https://www.miricam.net/" target="_blank"><font color = "#ccc">Miricam.com</font></a></font> </p> </section> </footer> </div> <!-- Scripts --> <script src="js/jquery-3.3.1.min.js"></script> <script src="js/jquery-ui.min.js"></script> <script src="js/gijgo.min.js"></script> <script src="js/bootstrap/bootstrap.min.js"></script> <script src="js/jquery.validate.min.js"></script> <script src="js/jquery.form.min.js"></script> <script src="js/loadingoverlay.min.js"></script> <script src="js/sweetalert.min.js"></script> <script src="js/skel.min.js"></script> <script src="js/util.js"></script> <script src="js/main.js"></script> <script src="js/custom.js"></script> </body> </html>