<form class="form-horizontal">
  <fieldset id="payment">
    <legend>{{ text_credit_card }}</legend>
    <div class="form-group required">
      <label class="col-sm-2 control-label" for="input-cc-type">{{ entry_cc_type }}</label>
      <div class="col-sm-10">
        <select name="cc_type" id="input-cc-type" class="form-control">          
          {% for card in cards %}
            <option value="{{ card.value }}">{{ card.text }}</option>
          {% endfor %}
        </select>
      </div>
    </div>
    <div class="form-group required">
      <label class="col-sm-2 control-label" for="input-cc-number">{{ entry_cc_number }}</label>
      <div class="col-sm-10">
        <input type="text" name="cc_number" value="" placeholder="{{ entry_cc_number }}" id="input-cc-number" class="form-control"/>
      </div>
    </div>
    <div class="form-group">
      <label class="col-sm-2 control-label" for="input-cc-start-date"><span data-toggle="tooltip" title="{{ help_start_date }}">{{ entry_cc_start_date }}</span></label>
      <div class="col-sm-3">
        <select name="cc_start_date_month" id="input-cc-start-date" class="form-control">          
          {% for month in months %}
            <option value="{{ month.value }}">{{ month.text }}</option>
          {% endfor %}
        </select>
      </div>
      <div class="col-sm-3">
        <select name="cc_start_date_year" class="form-control">          
          {% for year in year_valid %}
            <option value="{{ year.value }}">{{ year.text }}</option>
          {% endfor %}
        </select>
      </div>
    </div>
    <div class="form-group required">
      <label class="col-sm-2 control-label" for="input-cc-expire-date">{{ entry_cc_expire_date }}</label>
      <div class="col-sm-3">
        <select name="cc_expire_date_month" id="input-cc-expire-date" class="form-control">          
          {% for month in months %}
            <option value="{{ month.value }}">{{ month.text }}</option>
          {% endfor %}
        </select>
      </div>
      <div class="col-sm-3">
        <select name="cc_expire_date_year" class="form-control">          
          {% for year in year_expire %}
            <option value="{{ year.value }}">{{ year.text }}</option>
          {% endfor %}
        </select>
      </div>
    </div>
    <div class="form-group required">
      <label class="col-sm-2 control-label" for="input-cc-cvv2">{{ entry_cc_cvv2 }}</label>
      <div class="col-sm-10">
        <input type="text" name="cc_cvv2" value="" placeholder="{{ entry_cc_cvv2 }}" id="input-cc-cvv2" class="form-control"/>
      </div>
    </div>
    <div class="form-group">
      <label class="col-sm-2 control-label" for="input-cc-issue"><span data-toggle="tooltip" title="{{ help_issue }}">{{ entry_cc_issue }}</span></label>
      <div class="col-sm-10">
        <input type="text" name="cc_issue" value="" placeholder="{{ entry_cc_issue }}" id="input-cc-issue" class="form-control"/>
      </div>
    </div>
  </fieldset>
</form>
<div class="buttons">
  <div class="pull-right">
    <input type="button" value="{{ button_confirm }}" id="button-confirm" data-loading-text="{{ text_loading }}" class="btn btn-primary"/>
  </div>
</div>
<script type="text/javascript"><!--
    $('#button-confirm').bind('click', function() {
        $.ajax({
            url: 'index.php?route=extension/payment/pp_pro/send',
            type: 'post',
            data: $('#payment :input'),
            dataType: 'json',
            beforeSend: function() {
                $('#button-confirm').attr('disabled', true);
                $('#payment').before('<div class="alert alert-info"><i class="fa fa-info-circle"></i> {{ text_wait }}</div>');
            },
            complete: function() {
                $('.alert-dismissible').remove();
                $('#button-confirm').attr('disabled', false);
            },
            success: function (json) {
                if (json['error']) {
                  alert(json['error']);
                }
        
                if (json['success']) {
                  location = json['success'];
                }
            }
        });
    });
//--></script>