@extends($activeTemplate.'layouts.master')
@section('content')
<div class="card custom--card">
    <h5 class="card-header">
        @lang('NMI')
    </h5>
    <div class="card-body">
        <form role="form" id="payment-form" method="{{$data->method}}" action="{{$data->url}}">
            @csrf
            <div class="row">
                <div class="col-md-12">
                    <label class="form-label">@lang('Card Number')</label>
                    <div class="input-group">
                        <input type="tel" class="form-control form--control" name="billing-cc-number" autocomplete="off" value="{{ old('billing-cc-number') }}" required autofocus/>
                        <span class="input-group-text"><i class="fa fa-credit-card"></i></span>
                    </div>
                </div>
            </div>

            <div class="row mt-4">
                <div class="col-md-6">
                    <label class="form-label">@lang('Expiration Date')</label>
                    <input type="tel" class="form-control form--control" name="billing-cc-exp" value="{{ old('billing-cc-exp') }}" placeholder="e.g. MM/YY" autocomplete="off" required/>
                </div>
                <div class="col-md-6 ">
                    <label class="form-label">@lang('CVC Code')</label>
                    <input type="tel" class="form-control form--control" name="billing-cc-cvv" value="{{ old('billing-cc-cvv') }}" autocomplete="off" required/>
                </div>
            </div>
            <br>
            <button class="btn btn--base btn--lg w-100" type="submit"> @lang('Submit')</button>
        </form>
    </div>
</div>
@endsection