Card Holder's Name

{!! Form::text('card_firstname',$client->fldClientFirstname,array('pattern'=>'\w+.*','required','placeholder'=>'First name','title'=>'Fill your First name','class'=>'form-control','id'=>'card_firstname')) !!}

{!! Form::text('card_lastname',$client->fldClientLastname,array('pattern'=>'\w+.*','required','placeholder'=>'Last name','title'=>'Fill your Last name', 'class'=>'form-control','id'=>'card_lastname')) !!}

Card Number

{!! Form::text('card_number','',array('required','placeholder'=>'Card Number','title'=>'Enter Card Number','class'=>'form-control','id'=>'card_number')) !!}

{!! Form::text('card_cvv','',array('id'=>'card_cvv','required','class'=>'form-control','title'=>'Three or Four digits at back of your card','autocomplete'=>'off','maxlength'=>'4','id'=>'card_cvv','placeholder'=>'CVV')) !!}

{!! Html::image('_front/assets/images/card-details.png') !!}

Card Expiry Date

{!! Form::select('card_month',array('0' => 'Select one')+App\Models\Country::displayExpirationMonth(),date('m'),array('id'=>'card_month', 'class'=>'form-control', 'onchange'=>'focusYear()')) !!}

{!! Form::select('card_year',array('0' => 'Select one')+App\Models\Country::displayExpirationYear(),date('Y'),array('id'=>'card_year','class'=>'form-control', 'onchange'=>'focusCVV()')) !!}