-
Notifications
You must be signed in to change notification settings - Fork 0
/
Copy pathindex.html
108 lines (108 loc) · 5.62 KB
/
index.html
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
<!DOCTYPE html>
<html lang="es">
<head>
<meta charset="UTF-8" />
<meta name="viewport" content="width=device-width, initial-scale=1.0" />
<title>Formulario de Pago Único</title>
<!-- Bootstrap CSS -->
<link
href="https://cdn.jsdelivr.net/npm/[email protected]/dist/css/bootstrap.min.css"
rel="stylesheet"
/>
<!-- Font Awesome -->
<link
href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/6.0.0-beta3/css/all.min.css"
rel="stylesheet"
/>
<!-- Inputmask -->
<script src="https://cdnjs.cloudflare.com/ajax/libs/jquery/3.6.0/jquery.min.js"></script>
<script src="https://cdnjs.cloudflare.com/ajax/libs/inputmask/5.0.6/jquery.inputmask.min.js"></script>
<!-- Custom CSS -->
<link rel="stylesheet" href="styles.css" />
</head>
<body>
<div class="container my-5">
<div class="row justify-content-center">
<div class="col-12 col-md-10 col-lg-8">
<div class="card card-custom">
<div class="card-header card-header-custom text-center py-4">
<h3 class="mb-0">Formulario de Pago</h3>
</div>
<div class="card-body p-4">
<div id="error-msg" class="error-message d-none text-danger text-center">
Por favor, completa todos los campos requeridos.
</div>
<div id="success-msg" class="success-message d-none text-success text-center">
¡Pago realizado con éxito!
</div>
<form id="payment-form">
<div class="row g-3">
<div class="col-md-6">
<label for="card-number" class="form-label">Número de Tarjeta</label>
<input type="text" class="form-control" id="card-number" placeholder="1234 5678 9012 3456" required />
</div>
<div class="col-md-3">
<label for="cvc" class="form-label">CVC</label>
<input type="text" class="form-control" id="cvc" placeholder="123" maxlength="3" required />
</div>
<div class="col-md-3">
<label for="amount" class="form-label">Monto</label>
<div class="input-group">
<span class="input-group-text"><i class="fas fa-dollar-sign"></i></span>
<input type="number" class="form-control" id="amount" placeholder="100" required />
</div>
</div>
<div class="col-md-6">
<label for="first-name" class="form-label">Nombre</label>
<input type="text" class="form-control" id="first-name" placeholder="Juan" required />
</div>
<div class="col-md-6">
<label for="last-name" class="form-label">Apellido</label>
<input type="text" class="form-control" id="last-name" placeholder="Pérez" required />
</div>
<div class="col-md-6">
<label for="city" class="form-label">Ciudad</label>
<input type="text" class="form-control" id="city" placeholder="Ciudad" required />
</div>
<div class="col-md-3">
<label for="state" class="form-label">Estado</label>
<select class="form-select" id="state" required>
<option value="" selected disabled>Selecciona un estado</option>
<option value="CA">California</option>
<option value="TX">Texas</option>
<option value="NY">Nueva York</option>
</select>
</div>
<div class="col-md-3">
<label for="postal-code" class="form-label">Código Postal</label>
<input type="text" class="form-control" id="postal-code" placeholder="12345" maxlength="5" required />
</div>
<div class="col-12">
<p class="form-label">Métodos de Pago Aceptados:</p>
<div class="d-flex flex-wrap gap-2">
<button type="button" class="btn btn-outline-secondary"><i class="fab fa-cc-visa"></i></button>
<button type="button" class="btn btn-outline-secondary"><i class="fab fa-cc-mastercard"></i></button>
<button type="button" class="btn btn-outline-secondary"><i class="fab fa-cc-amex"></i></button>
<button type="button" class="btn btn-outline-secondary"><i class="fab fa-cc-paypal"></i></button>
</div>
</div>
<div class="col-12">
<label for="notes" class="form-label">Notas Adicionales</label>
<textarea class="form-control" id="notes" rows="3" placeholder="Escribe aquí..."></textarea>
</div>
</div>
<div class="d-flex justify-content-end gap-2 mt-4">
<button type="reset" class="btn btn-secondary">Cancelar</button>
<button type="submit" class="btn btn-custom">Enviar</button>
</div>
</form>
</div>
</div>
</div>
</div>
</div>
<script src="https://cdn.jsdelivr.net/npm/@popperjs/[email protected]/dist/umd/popper.min.js"></script>
<script src="https://cdn.jsdelivr.net/npm/[email protected]/dist/js/bootstrap.min.js"></script>
<script src="scripts.js"></script>
</body>
</html>