<div class="row wrapper border-bottom white-bg page-heading">
<div class="col-lg-10">
<h2>Credit card form</h2>
<ol class="breadcrumb">
<li>
<a href="index.html">Home</a>
</li>
<li>
<a>E-commerce</a>
</li>
<li class="active">
<strong>Credit card form</strong>
</li>
</ol>
</div>
</div>
<div class="wrapper wrapper-content animated fadeInRight">
<div class="row">
<div class="col-md-4">
<div class="payment-card">
<i class="fa fa-cc-visa payment-icon-big text-success"></i>
<h2>
**** **** **** 1060
</h2>
<div class="row">
<div class="col-sm-6">
<small>
<strong>Expiry date:</strong> 10/16
</small>
</div>
<div class="col-sm-6 text-right">
<small>
<strong>Name:</strong> David Williams
</small>
</div>
</div>
</div>
</div>
<div class="col-md-4">
<div class="payment-card">
<i class="fa fa-cc-mastercard payment-icon-big text-warning"></i>
<h2>
**** **** **** 7002
</h2>
<div class="row">
<div class="col-sm-6">
<small>
<strong>Expiry date:</strong> 10/16
</small>
</div>
<div class="col-sm-6 text-right">
<small>
<strong>Name:</strong> Anna Smith
</small>
</div>
</div>
</div>
</div>
<div class="col-md-4">
<div class="payment-card">
<i class="fa fa-cc-discover payment-icon-big text-danger"></i>
<h2>
**** **** **** 3466
</h2>
<div class="row">
<div class="col-sm-6">
<small>
<strong>Expiry date:</strong> 10/16
</small>
</div>
<div class="col-sm-6 text-right">
<small>
<strong>Name:</strong> Morgan Stanch
</small>
</div>
</div>
</div>
</div>
</div>
<div class="row">
<div class="col-lg-12">
<div class="ibox">
<div class="ibox-title">
Payment method
</div>
<div class="ibox-content">
<uib-accordion class="panel-group payments-method">
<uib-accordion-group>
<uib-accordion-heading>
<div class="pull-right">
<i class="fa fa-cc-paypal text-success"></i>
</div>
<h5 class="panel-title">
PayPal
</h5>
</uib-accordion-heading>
<div class="panel-body">
<div class="row">
<div class="col-md-10">
<h2>Summary</h2>
<strong>Product:</strong>: Name of product <br/>
<strong>Price:</strong>: <span class="text-navy">$452.90</span>
<p class="m-t">
Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do
eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut
enim ad minim veniam, quis nostrud exercitation ullamco laboris
nisi ut aliquip ex ea commodo consequat.
</p>
<a class="btn btn-success">
<i class="fa fa-cc-paypal">
Purchase via PayPal
</i>
</a>
</div>
</div>
</div>
</uib-accordion-group>
<uib-accordion-group is-open="true">
<uib-accordion-heading>
<div class="pull-right">
<i class="fa fa-cc-amex text-success"></i>
<i class="fa fa-cc-mastercard text-warning"></i>
<i class="fa fa-cc-discover text-danger"></i>
</div>
<h5 class="panel-title">
Credit Card
</h5>
</uib-accordion-heading>
<div class="panel-body">
<div class="row">
<div class="col-md-4">
<h2>Summary</h2>
<strong>Product:</strong>: Name of product <br/>
<strong>Price:</strong>: <span class="text-navy">$452.90</span>
<p class="m-t">
Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do
eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut
enim ad minim veniam, quis nostrud exercitation ullamco laboris
nisi ut aliquip ex ea commodo consequat.
</p>
<p>
Duis aute irure dolor
in reprehenderit in voluptate velit esse cillum dolore eu fugiat
nulla pariatur. Excepteur sint occaecat cupidatat.
</p>
</div>
<div class="col-md-8">
<form role="form" id="payment-form">
<div class="row">
<div class="col-xs-12">
<div class="form-group">
<label>CARD NUMBER</label>
<div class="input-group">
<input type="text" class="form-control" name="Number" placeholder="Valid Card Number" required />
<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>EXPIRATION DATE</label>
<input type="text" class="form-control" name="Expiry" placeholder="MM / YY" required/>
</div>
</div>
<div class="col-xs-5 col-md-5 pull-right">
<div class="form-group">
<label>CV CODE</label>
<input type="text" class="form-control" name="CVC" placeholder="CVC" required/>
</div>
</div>
</div>
<div class="row">
<div class="col-xs-12">
<div class="form-group">
<label>NAME OF CARD</label>
<input type="text" class="form-control" name="nameCard" placeholder="NAME AND SURNAME"/>
</div>
</div>
</div>
<div class="row">
<div class="col-xs-12">
<button class="btn btn-primary" type="submit">Make a payment!</button>
</div>
</div>
</form>
</div>
</div>
</div>
</uib-accordion-group>
</uib-accordion>
</div>
</div>
</div>
</div>
</div>