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| payonline:reoccurring [2016/11/15 15:32] – iamed | payonline:reoccurring [2017/06/28 18:06] (current) – external edit 127.0.0.1 |
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| | <script type="text/javascript"> JotForm.setCalculations([{"decimalPlaces":"2","equation":"[{6}]","ignoreHiddenFields":"","insertAsText":"","newCalculationType":"1","operands":"6","readOnly":"","replaceText":"","resultField":"8","showBeforeInput":"","showEmptyDecimals":"","useCommasForDecimals":""}]); JotForm.init(function(){ productID = {"0":"input_5_1000"}; paymentType = "subscription"; JotForm.setCurrencyFormat('USD',true, 'point'); JotForm.totalCounter({"input_5_1000":{"price":"custom"}}); JotForm.alterTexts(undefined, true); JotForm.clearFieldOnHide="disable"; JotForm.onSubmissionError="jumpToFirstError"; }); |
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| | <style type="text/css"> .form-label-left{ width:150px !important; } .form-line{ padding-top:12px; padding-bottom:12px; } .form-label-right{ width:150px !important; } .form-all{ width:690px; color:#555 !important; font-family:"Lucida Grande", "Lucida Sans Unicode", "Lucida Sans", Verdana, sans-serif; font-size:14px; } .form-radio-item label, .form-checkbox-item label, .form-grading-label, .form-header{ color: #555; } </style> <form class="jotform-form" action="https://submit.jotform.us/submit/63160139574153/" method="post" name="form_63160139574153" id="63160139574153" accept-charset="utf-8"> <input type="hidden" name="formID" value="63160139574153" /> <div class="form-all"> <ul class="form-section page-section"> <li id="cid_11" class="form-input-wide" data-type="control_head"> <div class="form-header-group"> <div class="header-text httal htvam"> <h3 id="header_11" class="form-header"> Set Up A Reoccurring Monthly Payment </h3> <div id="subHeader_11" class="form-subHeader"> Reoccurring Payments may be canceled at http://www.dwolla.com/ </div> </div> </div> </li> <li class="form-line jf-required" data-type="control_fullname" id="id_4"> <label class="form-label form-label-left form-label-auto" id="label_4" for="input_4"> Name <span class="form-required"> * </span> </label> <div id="cid_4" class="form-input jf-required"> <span class="form-sub-label-container" style="vertical-align: top;"> <input class="form-textbox validate[required]" type="text" size="10" name="q4_name[first]" id="first_4" /> <label class="form-sub-label" for="first_4" id="sublabel_first" style="min-height: 13px;"> First Name </label> </span> <span class="form-sub-label-container" style="vertical-align: top;"> <input class="form-textbox validate[required]" type="text" size="15" name="q4_name[last]" id="last_4" /> <label class="form-sub-label" for="last_4" id="sublabel_last" style="min-height: 13px;"> Last Name </label> </span> </div> </li> <li class="form-line jf-required" data-type="control_radio" id="id_6"> <label class="form-label form-label-left form-label-auto" id="label_6" for="input_6"> Amount to Pay <span class="form-required"> * </span> </label> <div id="cid_6" class="form-input jf-required"> <div class="form-single-column"> <span class="form-radio-item" style="clear:left;"> <span class="dragger-item"> </span> <input type="radio" class="form-radio validate[required]" id="input_6_0" name="q6_amountTo" data-calcvalue="880" value="Full unit rent - $880.00" /> <label id="label_input_6_0" for="input_6_0"> Full unit rent - $880.00 </label> </span> <span class="form-radio-item" style="clear:left;"> <span class="dragger-item"> </span> <input type="radio" class="form-radio validate[required]" id="input_6_1" name="q6_amountTo" data-calcvalue="440" value="Single room rent - $440.00" /> <label id="label_input_6_1" for="input_6_1"> Single room rent - $440.00 </label> </span> <span class="form-radio-item" style="clear:left;"> <span class="dragger-item"> </span> <input type="radio" class="form-radio validate[required]" id="input_6_2" name="q6_amountTo" data-calcvalue="293.34" value="3 person unit rent - $293.34" /> <label id="label_input_6_2" for="input_6_2"> 3 person unit rent - $293.34 </label> </span> <span class="form-radio-item" style="clear:left"> <input type="radio" class="form-radio-other form-radio validate[required]" name="q6_amountTo" id="other_6" value="other" /> <input type="text" class="form-radio-other-input form-textbox" name="q6_amountTo[other]" data-otherHint="Other" size="15" id="input_6" /> <br /> </span> </div> </div> </li> <li class="form-line always-hidden" data-type="control_calculation" id="id_8"> <label class="form-label form-label-left form-label-auto" id="label_8" for="input_8"> Calculation </ |