<?php
ob_start();
session_start();
include('headMain2.php');
if ($_SESSION['formNo']==''){
    $formNo=$_SESSION['transID'];
}else{
    $formNo=$_SESSION['formNo'];
}

$names=$_SESSION['otherNames'];
$email= $_SESSION['email'];
$gsm=$_SESSION['gsm'];

?>
<script type="text/javascript" language="javascript" src="../js/jquery-1.7.1.js"></script>

<div id="wrapper">
    <table width="100%" align="center" cellpadding="3" cellspacing="5">
        <tr>
            <td><fieldset>
                    <form id="form1" name="form1" method="post" action="postjson_question.php" role="form">
                        <fieldset>
                            <legend>
                                <div class="row">
                                    <div class="col-lg-2"></div>
                                    <div class="col-lg-8">
                                        <div class="panel panel-default">
                                            <div class="panel-heading">
                                               Payment Gateway for e-Preparatory Materials
                                            </div>
                                            <div class="panel-body">

                                                <div class="row">
                                                    <div class="col-lg-12">
                                                        <form role="form">
                                                                <table width="100%" align="center" >
                                                                    <tbody>

                                                                    <tr>
                                                                        <td width="40%">ID No (Matric No/Staff No/Tender No.)</td>
                                                                        <td><input name="idNo" type="text" required="required" id="idNo" value="<?php echo $formNo;?>" class="form-control" /></td>

                                                                    </tr>
                                                                    <tr>
                                                                        <td width="200">Payer Full Name:</td>
                                                                        <td id="names"><input name="payerName" type="text"  class="form-control" value="<?php echo $names;?>" size="45" readonly="readonly" id="payerName"></td>
                                                                    </tr>
                                                                    <tr>
                                                                        <td width="60%">Payer Email: <font
                                                                                color="red">*</font></td>
                                                                        <td><input name="payerEmail" required value="<?php echo $email;?>"
                                                                                   type="email" class="form-control">
                                                                        </td>
                                                                    </tr>
                                                                    <tr>
                                                                        <td>Payer Phone:</td>
                                                                        <td><input name="payerPhone" value="<?php echo $gsm;?>"
                                                                                   type="text" class="form-control">
                                                                        </td>
                                                                    </tr>
                                                                    <tr>
                                                                        <td>Payment Type</td>
                                                                        <td><label for="ptype"></label>
                                                                            <select name="ptype" id="ptype"  class="form-control">
                                                                                <option value="eQuestion,1000,0">Payment for eQuestion</option>

                                                                            </select></td>
                                                                    </tr>
                                                                    <tr>
                                                                        <td width="40%">Payment Description</td>
                                                                        <td><input name="pdis" type="text" required="required" id="pdis" value="Payment for eQuestion" class="form-control" /></td>

                                                                    </tr>



                                                                    <tr>
                                                                        <td width="200">Amount: <font color="red">*</font></td>
                                                                        <td id="amt2"><input name="amt" type="text" required value="1000"  class="form-control"readonly="readonly" id="amt"></td>
                                                                    </tr>
<!--                                                                    <tr>-->
<!--                                                                        <td width="200">Processing Fee: <font color="red">*</font></td>-->
<!--                                                                        <td id="amt2c"><input name="amtc" type="text" required value="0"  class="form-control"readonly="readonly" id="amtc"></td>-->
<!--                                                                    </tr>-->
                                                                    <tr>
                                                                        <td width="200">Payment Method Type:</td>
                                                                        <td>
                                                                            <select class="required-entry form-control"
                                                                                    title="Credit Card Type"
                                                                                    name="paymenttype" id="paymenttype"
                                                                                    autocomplete="off">
                                                                                <option>-- Select Payment Type --
                                                                                </option>
                                                                                <option value="VERVE"> Verve Card
                                                                                </option>
                                                                                <option value="VISA"> Visa</option>
                                                                                <option value="MASTERCARD"> MasterCard
                                                                                </option>
                                                                                <option value="POCKETMONI"> PocketMoni
                                                                                </option>
                                                                                <option value="POS"> POS</option>
                                                                                <option value="ATM"> ATM</option>
                                                                                <option value="BANK_BRANCH">BANK
                                                                                    BRANCH
                                                                                </option>
                                                                                <option value="BANK_INTERNET">BANK
                                                                                    INTERNET
                                                                                </option>
                                                                                <option value="REMITA_PAY"> Remita
                                                                                    Account Transfer
                                                                                </option>
                                                                            </select>
                                                                        </td>
                                                                    </tr>
                                                                    <tr>
                                                                        <td width="200"></td>
                                                                        <td><p></p><input type="submit" name="" value="Pay"
                                                                                          class="btn btn-primary form-control">
                                                                            <img src="../images/remitaLogo.jpg"
                                                                                 alt="" width="418" height="90"/></td>
                                                                    </tr>
                                                                    </tbody>
                                                                </table>
                                                            <div> <a href="paymentHistoryQuestion.php"> Click to check Payment History</a></div>
                                                        </form>
                                                    </div>
                                                </div>
                                            </div>
                                        </div>
                                    </div>
                                </div>
                            </legend>
                        </fieldset>
                    </form>
                </fieldset>
            </td>
        </tr>
    </table>

    <?php
    include('footMain.php');
    ?>
</div>