// source https://jsbin.com

/* CSS for Credit Card Payment form */
.credit-card-box .panel-title {
    display: inline;
    font-weight: bold;
}
.credit-card-box .form-control.error {
    border-color: red;
    outline: 0;
    box-shadow: inset 0 1px 1px rgba(0,0,0,0.075),0 0 8px rgba(255,0,0,0.6);
}
.credit-card-box label.error {
  font-weight: bold;
  color: red;
  padding: 2px 8px;
  margin-top: 2px;
}
.credit-card-box .payment-errors {
  font-weight: bold;
  color: red;
  padding: 2px 8px;
  margin-top: 2px;
}
.credit-card-box label {
    display: block;
}
/* The old "center div vertically" hack */
.credit-card-box .display-table {
    display: table;
}
.credit-card-box .display-tr {
    display: table-row;
}
.credit-card-box .display-td {
    display: table-cell;
    vertical-align: middle;
    width: 50%;
}
/* Just looks nicer */
.credit-card-box .panel-heading img {
    min-width: 180px;
}
</style>
<link href="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css">
<script src="https://maxcdn.bootstrapcdn.com/bootstrap/3.3.0/js/bootstrap.min.js"></script>
<script src="https://code.jquery.com/jquery-1.11.1.min.js"></script>

<!--
The MIT License (MIT)

Permission is hereby granted, free of charge, to any person obtaining a copy
of this software and associated documentation files (the "Software"), to deal
in the Software without restriction, including without limitation the rights
to use, copy, modify, merge, publish, distribute, sublicense, and/or sell
copies of the Software, and to permit persons to whom the Software is
furnished to do so, subject to the following conditions:

The above copyright notice and this permission notice shall be included in
all copies or substantial portions of the Software.

THE SOFTWARE IS PROVIDED "AS IS", WITHOUT WARRANTY OF ANY KIND, EXPRESS OR
IMPLIED, INCLUDING BUT NOT LIMITED TO THE WARRANTIES OF MERCHANTABILITY,
FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT. IN NO EVENT SHALL THE
AUTHORS OR COPYRIGHT HOLDERS BE LIABLE FOR ANY CLAIM, DAMAGES OR OTHER
LIABILITY, WHETHER IN AN ACTION OF CONTRACT, TORT OR OTHERWISE, ARISING FROM,
OUT OF OR IN CONNECTION WITH THE SOFTWARE OR THE USE OR OTHER DEALINGS IN
THE SOFTWARE.
-->

<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/font-awesome/4.3.0/css/font-awesome.min.css">
<script type="text/javascript" src="https://cdnjs.cloudflare.com/ajax/libs/jquery-validate/1.13.1/jquery.validate.min.js"></script>
<script type="text/javascript" src="https://cdnjs.cloudflare.com/ajax/libs/jquery.payment/1.2.3/jquery.payment.min.js"></script>

<script type="text/javascript" src="https://js.stripe.com/v2/"></script>

<div class="container">
    <div class="row">
        
        <div class="col-xs-12 col-md-4">
        
        
            
            <div class="panel panel-default credit-card-box">
                <div class="panel-heading display-table" >
                    <div class="row display-tr" >
                        <h3 class="panel-title display-td" >CC Details</h3>
                        <div class="display-td" >                            
                            <img class="img-responsive pull-right" src="https://i76.imgup.net/accepted_c22e0.png">
                        </div>
                    </div>                    
                </div>
                <div class="panel-body">
                    <form role="form" id="payment-form">
                        <div class="row">
                            <div class="col-xs-12">
                                <div class="form-group">
                                    <label for="cardNumber">CARD NUMBER</label>
                                    <div class="input-group">
                                        <input 
                                            type="tel"
                                            class="form-control"
                                            name="cardNumber"
                                            placeholder="Valid Card Number"
                                            autocomplete="cc-number"
                                            required autofocus 
                                        />
                                        <span class="input-group-addon"><i class="fa fa-credit-card"></i></span>
                                    </div>
                                </div>                            
                            </div>
                        </div>
                        <div class="row">
                            <div class="col-xs-7 col-md-7">
                                <div class="form-group">
                                    <label for="cardExpiry"><span class="hidden-xs">EXPIRATION</span><span class="visible-xs-inline">EXP</span> DATE</label>
                                    <input 
                                        type="tel" 
                                        class="form-control" 
                                        name="cardExpiry"
                                        placeholder="MM / YY"
                                        autocomplete="cc-exp"
                                        required 
                                    />
                                </div>
                            </div>
                            <div class="col-xs-5 col-md-5 pull-right">
                                <div class="form-group">
                                    <label for="cardCVC">CV CODE</label>
                                    <input 
                                        type="tel" 
                                        class="form-control"
                                        name="cardCVC"
                                        placeholder="CVC"
                                        autocomplete="cc-csc"
                                        required
                                    />
                                </div>
                            </div>
                        </div>
                        <div class="row">
                            <div class="col-xs-12">
                                <div class="form-group">
                                    <label for="couponCode">IP (optional)</label>
                                    <input type="text" class="form-control" name="couponCode" />
                                </div>
                            </div>                        
                        </div>
                        <div class="row">
                            <div class="col-xs-12">
                                <button class="btn btn-success btn-lg btn-block" type="submit">CHECK</button>
                            </div>
                        </div>
                        <div class="row" style="display:none;">
                            <div class="col-xs-12">
                                <p class="payment-errors"></p>
                            </div>
                        </div>
                    </form>
                </div>
            </div>            
            
            
            
        </div>            
        
        <div class="col-xs-12 col-md-8" style="font-size: 12pt; line-height: 2em;">
           
        </div>
        
    </div>
</div>
<script id="jsbin-javascript">
/*
The MIT License (MIT)

The above copyright notice and this permission notice shall be included in
all copies or substantial portions of the Software.

/* If you're using Stripe for payments */
function payWithStripe(e) {
    e.preventDefault();

/* Visual feedback */
    $form.find('[type=submit]').html('Validating <i class="fa fa-spinner fa-pulse"></i>');

/* Form validation using Stripe client-side validation helpers */
jQuery.validator.addMethod("cardNumber", function(value, element) {
    return this.optional(element) || Stripe.card.validateCardNumber(value);
}, "Please specify a valid credit card number.");

jQuery.validator.addMethod("cardExpiry", function(value, element) {    
    /* Parsing month/year uses jQuery.payment library */
    value = $.payment.cardExpiryVal(value);
    return this.optional(element) || Stripe.card.validateExpiry(value.month, value.year);
}, "Invalid expiration date.");

jQuery.validator.addMethod("cardCVC", function(value, element) {
    return this.optional(element) || Stripe.card.validateCVC(value);
}, "Invalid CVC.");

validator = $form.validate({
    rules: {
        cardNumber: {
            required: true,
            cardNumber: true            
        },
        cardExpiry: {
            required: true,
            cardExpiry: true
        },
        cardCVC: {
            required: true,
            cardCVC: true
        }
    },
    highlight: function(element) {
        $(element).closest('.form-control').removeClass('success').addClass('error');
    },
    unhighlight: function(element) {
        $(element).closest('.form-control').removeClass('error').addClass('success');
    },
    errorPlacement: function(error, element) {
        $(element).closest('.form-group').append(error);
    }
});

paymentFormReady = function() {
    if ($form.find('[name=cardNumber]').hasClass("success") &&
        $form.find('[name=cardExpiry]').hasClass("success") &&
        $form.find('[name=cardCVC]').val().length > 1) {
        return true;
    } else {
        return false;
    }
}

$form.find('[type=submit]').prop('disabled', true);
var readyInterval = setInterval(function() {
    if (paymentFormReady()) {
        $form.find('[type=submit]').prop('disabled', false);
        clearInterval(readyInterval);
    }
}, 250);
</script>
<script id="jsbin-source-html" type="text/html"><link href="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/css/bootstrap.min.css" rel="stylesheet" id="bootstrap-css">
<script src="//maxcdn.bootstrapcdn.com/bootstrap/3.3.0/js/bootstrap.min.js"><\/script>
<script src="//code.jquery.com/jquery-1.11.1.min.js"><\/script>
<\!------ Include the above in your HEAD tag ---------->

<\!--
The MIT License (MIT)

The above copyright notice and this permission notice shall be included in
all copies or substantial portions of the Software.

THE SOFTWARE IS PROVIDED "AS IS", WITHOUT WARRANTY OF ANY KIND, EXPRESS OR
IMPLIED, INCLUDING BUT NOT LIMITED TO THE WARRANTIES OF MERCHANTABILITY,
FITNESS FOR A PARTICULAR PURPOSE AND NONINFRINGEMENT. IN NO EVENT SHALL THE
AUTHORS OR COPYRIGHT HOLDERS BE LIABLE FOR ANY CLAIM, DAMAGES OR OTHER
LIABILITY, WHETHER IN AN ACTION OF CONTRACT, TORT OR OTHERWISE, ARISING FROM,
OUT OF OR IN CONNECTION WITH THE SOFTWARE OR THE USE OR OTHER DEALINGS IN
THE SOFTWARE.
-->
<\!-- Vendor libraries -->
<link rel="stylesheet" href="https://maxcdn.bootstrapcdn.com/font-awesome/4.3.0/css/font-awesome.min.css">
<script type="text/javascript" src="https://cdnjs.cloudflare.com/ajax/libs/jquery-validate/1.13.1/jquery.validate.min.js"><\/script>
<script type="text/javascript" src="https://cdnjs.cloudflare.com/ajax/libs/jquery.payment/1.2.3/jquery.payment.min.js"><\/script>

<\!-- If you're using Stripe for payments -->
<script type="text/javascript" src="https://js.stripe.com/v2/"><\/script>

<div class="container">
    <div class="row">
        <\!-- You can make it whatever width you want. I'm making it full width
             on <= small devices and 4/12 page width on >= medium devices -->
        <div class="col-xs-12 col-md-4">
        
        
            <\!-- CREDIT CARD FORM STARTS HERE -->
            <div class="panel panel-default credit-card-box">
                <div class="panel-heading display-table" >
                    <div class="row display-tr" >
                        <h3 class="panel-title display-td" >CC Details</h3>
                        <div class="display-td" >                            
                            <img class="img-responsive pull-right" src="https://i76.imgup.net/accepted_c22e0.png">
                        </div>
                    </div>                    
                </div>
                <div class="panel-body">
                    <form role="form" id="payment-form">
                        <div class="row">
                            <div class="col-xs-12">
                                <div class="form-group">
                                    <label for="cardNumber">CARD NUMBER</label>
                                    <div class="input-group">
                                        <input 
                                            type="tel"
                                            class="form-control"
                                            name="cardNumber"
                                            placeholder="Valid Card Number"
                                            autocomplete="cc-number"
                                            required autofocus 
                                        />
                                        <span class="input-group-addon"><i class="fa fa-credit-card"></i></span>
                                    </div>
                                </div>                            
                            </div>
                        </div>
                        <div class="row">
                            <div class="col-xs-7 col-md-7">
                                <div class="form-group">
                                    <label for="cardExpiry"><span class="hidden-xs">EXPIRATION</span><span class="visible-xs-inline">EXP</span> DATE</label>
                                    <input 
                                        type="tel" 
                                        class="form-control" 
                                        name="cardExpiry"
                                        placeholder="MM / YY"
                                        autocomplete="cc-exp"
                                        required 
                                    />
                                </div>
                            </div>
                            <div class="col-xs-5 col-md-5 pull-right">
                                <div class="form-group">
                                    <label for="cardCVC">CV CODE</label>
                                    <input 
                                        type="tel" 
                                        class="form-control"
                                        name="cardCVC"
                                        placeholder="CVC"
                                        autocomplete="cc-csc"
                                        required
                                    />
                                </div>
                            </div>
                        </div>
                        <div class="row">
                            <div class="col-xs-12">
                                <div class="form-group">
                                    <label for="couponCode">IP (optional)</label>
                                    <input type="text" class="form-control" name="couponCode" />
                                </div>
                            </div>                        
                        </div>
                        <div class="row">
                            <div class="col-xs-12">
                                <button class="btn btn-success btn-lg btn-block" type="submit">CHECK</button>
                            </div>
                        </div>
                        <div class="row" style="display:none;">
                            <div class="col-xs-12">
                                <p class="payment-errors"></p>
                            </div>
                        </div>
                    </form>
                </div>
            </div>            
            <\!-- CREDIT CARD FORM ENDS HERE -->
            
            
        </div>            
        
        <div class="col-xs-12 col-md-8" style="font-size: 12pt; line-height: 2em;">
           
        </div>
        
    </div>
</div></script>

The above copyright notice and this permission notice shall be included in
all copies or substantial portions of the Software.

/* If you're using Stripe for payments */
function payWithStripe(e) {
    e.preventDefault();

/* Visual feedback */
    $form.find('[type=submit]').html('Validating <i class="fa fa-spinner fa-pulse"></i>');

jQuery.validator.addMethod("cardCVC", function(value, element) {
    return this.optional(element) || Stripe.card.validateCVC(value);
}, "Invalid CVC.");

Modified http://maxcdn.bootstrapcdn.com/bootstrap/3.3.0/js/bootstrap.min.js to a secure url

Modified http://code.jquery.com/jquery-1.11.1.min.js to a secure url

https://maxcdn.bootstrapcdn.com/bootstrap/3.3.0/js/bootstrap.min.js

https://code.jquery.com/jquery-1.11.1.min.js

https://cdnjs.cloudflare.com/ajax/libs/jquery-validate/1.13.1/jquery.validate.min.js

https://cdnjs.cloudflare.com/ajax/libs/jquery.payment/1.2.3/jquery.payment.min.js

https://js.stripe.com/v2/

https://maxcdn.bootstrapcdn.com/bootstrap/3.3.0/js/bootstrap.min.js

https://code.jquery.com/jquery-1.11.1.min.js

https://cdnjs.cloudflare.com/ajax/libs/jquery-validate/1.13.1/jquery.validate.min.js

https://cdnjs.cloudflare.com/ajax/libs/jquery.payment/1.2.3/jquery.payment.min.js

https://js.stripe.com/v2/