{% extends 'CPPViawestPortalBundle:Default:base.html.twig' %}
{% block title %}Account - Add Billing Profile{% endblock %}
 
{% block pagecontent %}
<style type="text/css">

	textarea:focus, input:focus {
border: 1px solid #09C;
}
	input    {
/*width:375px; */
/*display:block; */
border: 1px solid #999;
/* height: 25px; */
-webkit-box-shadow: 0px 0px 8px rgba(0, 0, 0, 0.3);
-moz-box-shadow: 0px 0px 8px rgba(0, 0, 0, 0.3);
box-shadow: 0px 0px 8px rgba(0, 0, 0, 0.3);
}
	
	


	
.required {
	color: #F00;
}

    .savebutton {
        -moz-box-shadow:inset 0px 1px 0px 0px #ffffff;
        -webkit-box-shadow:inset 0px 1px 0px 0px #ffffff;
        box-shadow:inset 0px 1px 0px 0px #ffffff;
        background:-webkit-gradient( linear, left top, left bottom, color-stop(0.05, #58bce3), color-stop(1, #4052db) );
        background:-moz-linear-gradient( center top, #58bce3 5%, #4052db 100% );
        filter:progid:DXImageTransform.Microsoft.gradient(startColorstr='#58bce3', endColorstr='#4052db');
        background-color:#58bce3;
        -moz-border-radius:6px;
        -webkit-border-radius:6px;
        border-radius:6px;
        border:1px solid #dcdcdc;
        display:inline-block;
        color:#fff;
        font-family:arial;
        font-size:15px;
        font-weight:bold;
        height: 30px;
    }
    .savebutton:hover {
        cursor: pointer;
    }
    .savebutton:active {
        position:relative;
        top:1px;
    }
</style>
<script>

/*
Auto tabbing script- By JavaScriptKit.com
http://www.javascriptkit.com
This credit MUST stay intact for use
*/

function autotab(original,destination){
if (original.getAttribute&&original.value.length==original.getAttribute("maxlength"))
destination.focus()
}

</script>
<div id="" style="overflow-y: scroll; height:600px;">
<table border="0" width="100%"><tr><td>
<h2 class="box-contents">Add a Billing Profile:</h2>
<hr />
{% if data.msg is defined %}
		<span class="box-contents"><b>{{ data.msg }}</b></span><br />
{% endif %}

{% if data.msg2 is defined %}
		<h2 class="box-contents">{{ data.msg2 }}</h2>
{% endif %}
		
</td></tr>
<tr><td class="content-text">
 {{ form_start(form, { 'attr': {'name': 'details'} }) }}
 {{ form_errors(form) }}
<table class="content-text" width="100%">
       
       <tr><td colspan="2"><strong>Profile Nickname:</strong><br />
       (used only to identify this profile at checkout)<br />
        {{ form_errors(form.nickname) }}
        {{ form_widget(form.nickname) }}</td><td colspan="2"><strong>First/Last Name:</strong><br />
        (as it appears on card)<br />
         {{ form_errors(form.nameoncard) }}
        {{ form_widget(form.nameoncard) }}
         {{ form_errors(form.lnameoncard) }}
        {{ form_widget(form.lnameoncard) }}
        </td></tr>
        <tr><td colspan="4"><strong>Billing Address:</strong></td></tr>
         <tr><td colspan="4">ATTN:(optional, used when you ship to this address) {{ form_errors(form.add2) }}{{ form_widget(form.add2) }}</td></tr>
        <tr><td colspan="4">Address: {{ form_errors(form.add1) }}{{ form_widget(form.add1) }}</td></tr>
        <tr><td colspan="4">City: {{ form_errors(form.city) }}{{ form_widget(form.city) }}</td></tr>
        <tr><td colspan="4">State: {{ form_errors(form.state) }}{{ form_widget(form.state) }}</td></tr>
        <tr><td colspan="4">Zip Code: {{ form_errors(form.zip) }}{{ form_widget(form.zip) }}</td></tr>
        <tr><td colspan="4"><strong>Card Number:</strong></td></tr>
        <tr><td colspan="4" align="left">
        <table>
         <tr><td>{{ form_errors(form.cc1) }}
        {{ form_widget(form.cc1) }}
        -</td><td>
        {{ form_errors(form.cc2) }}
        {{ form_widget(form.cc2) }}
        -</td><td>
        {{ form_errors(form.cc3) }}
        {{ form_widget(form.cc3) }}
        -</td><td>
       {{ form_errors(form.cc4) }}
        {{ form_widget(form.cc4) }}
        </td></tr>
        
        </table>
        </td></tr>
        
        <tr><td colspan="2" align="left"><strong>EXP Date:</strong><br />
        (EX 02 16) = Feb 2016
        </td><td colspan="2"><strong>Card Type:</strong><br />
        (choose one)</td></tr>
        
        <tr><td colspan="2" align="left">
        <table border="0" class="content-text"> 
       <tr><td align="right">MM /</td><td align="left"> YY</td></tr>
        <tr><td align="right"> {{ form_errors(form.ccexpmo) }}
        {{ form_widget(form.ccexpmo) }}</td>
        <td align="left"> {{ form_errors(form.ccexpyr) }}
        {{ form_widget(form.ccexpyr) }}</td></tr>
       </table>
        
        </td>
        <td colspan="2"> {{ form_errors(form.cardtype) }}
        {{ form_widget(form.cardtype) }}</td>
        </tr>
        <tr><td colspan="2"><strong>CVV Code (3-4 digits in signature strip)</strong></td>
        <td colspan="2">{{ form_errors(form.cvv) }}
        {{ form_widget(form.cvv) }}</td>
        </tr>
         </table>

 {{ form_widget(form.Save) }}
{{ form_end(form) }}
</td></tr>

</table>
</div>
{% endblock %}