<%@ page language="VB" masterpagefile="~/Template/Master_Client.master" autoeventwireup="false" inherits="Client_NewPayProfile, MachSol.MachPanel.Web" %>

<%@ Register Assembly="AjaxControlToolkit" Namespace="AjaxControlToolkit" TagPrefix="cc1" %>
<asp:Content ID="Content1" ContentPlaceHolderID="CPH_Content" runat="Server">
    <asp:Panel ID="Pnl_save" runat="server" DefaultButton="Btn_Add" class="col-xs-12">
        <div class="card">
            <div class="header">
                <h2>
                    <asp:Literal ID="Ltl_SubsInfo" runat="server" /></h2>
            </div>
            <div class="body">
                <div class="row">
                    <div class="col-xs-12">
                        <div class="card">
                            <div class="header">
                                <h3>
                                    <asp:Literal ID="Div2" runat="server" Text='<%$ Resources:Content, GN0000891 %>' EnableViewState="false" />
                                </h3>
                            </div>
                            <div class="body">
                                <div class="row">
                                    <div class="col-sm-3 col-xs-12 row-label">
                                        <label>
                                            *<asp:Literal ID="Div8" runat="server" Text='<%$ Resources:Content, GN0000872 %>'
                                                EnableViewState="false" />:</label>
                                    </div>
                                    <div class="col-sm-4 col-xs-12">
                                        <div class="form-group">
                                            <div class="form-line">
                                                <asp:TextBox ID="TxBx_NameOnCard" runat="server" MaxLength="60"></asp:TextBox>
                                                <asp:RequiredFieldValidator ID="RequiredFieldValidator1" runat="server" Display="None"
                                                    SetFocusOnError="True" ControlToValidate="TxBx_NameOnCard" ValidationGroup="addcard"></asp:RequiredFieldValidator>
                                            </div>
                                        </div>
                                    </div>
                                </div>
                                <div class="row">
                                    <div class="col-sm-3 col-xs-12 row-label">
                                        <label>
                                            <asp:Literal ID="Div3" runat="server" Text='<%$ Resources:Content, GN0000673 %>'
                                                EnableViewState="false" />:</label>
                                    </div>
                                    <div class="col-sm-4 col-xs-12">
                                        <div class="form-group">
                                            <asp:DropDownList ID="DDL_CreditCardTypes" runat="server">
                                            </asp:DropDownList>
                                        </div>
                                    </div>
                                </div>
                                <div class="row">
                                    <div class="col-sm-3 col-xs-12 row-label">
                                        <label>
                                            *<asp:Literal ID="Div4" runat="server" Text='<%$ Resources:Content, GN0000841 %>'
                                                EnableViewState="false" />:</label>
                                    </div>
                                    <div class="col-sm-4 col-xs-12">
                                        <div class="form-group">
                                            <div class="form-line">
                                                <asp:TextBox ID="TxBx_CardNumber" runat="server" MaxLength="16" onChange='ValidateCreditCard(this);'></asp:TextBox>
                                                <%--<asp:RegularExpressionValidator ErrorMessage="<%$ Resources:Content,DGN1110072%>"
                                    ID="RegularExpressionValidator4" runat="server" ControlToValidate="TxBx_CardNumber"
                                    Display="None" SetFocusOnError="True" ValidationExpression="<%$ Resources:Content,CreditCardExpression %>" ValidationGroup="addcard"></asp:RegularExpressionValidator>--%>
                                                <asp:RequiredFieldValidator ID="RequiredFieldValidator2" runat="server" Display="None"
                                                    SetFocusOnError="True" ControlToValidate="TxBx_CardNumber" ValidationGroup="addcard"></asp:RequiredFieldValidator>
                                                <cc1:FilteredTextBoxExtender ID="FilteredTextBoxExtender3" runat="server" TargetControlID="TxBx_CardNumber"
                                                    FilterType="Numbers">
                                                </cc1:FilteredTextBoxExtender>
                                            </div>
                                        </div>
                                    </div>
                                </div>
                                <div class="row">
                                    <div class="col-sm-3 col-xs-12 row-label">
                                        <label>
                                            <asp:Literal ID="Div7" runat="server" Text='<%$ Resources:Content, GN0000871 %>'
                                                EnableViewState="false" />:</label>
                                    </div>
                                    <div class="col-sm-4 col-xs-12">
                                        <div class="form-group">
                                            <asp:DropDownList ID="DDL_Years" runat="server">
                                            </asp:DropDownList>
                                        </div>
                                    </div>
                                </div>
                                <div class="row">
                                    <div class="col-sm-3 col-xs-12 row-label">
                                        <label>
                                            <asp:Literal ID="Div6" runat="server" Text='<%$ Resources:Content, GN0000870 %>'
                                                EnableViewState="false" />:</label>
                                    </div>
                                    <div class="col-sm-4 col-xs-12">
                                        <div class="form-group">
                                            <asp:DropDownList ID="DDL_Months" runat="server">
                                                <asp:ListItem Text='<%$ Resources:Content, GN00001032 %>' Value="1"></asp:ListItem>
                                                <asp:ListItem Text='<%$ Resources:Content, GN00001033 %>' Value="2"></asp:ListItem>
                                                <asp:ListItem Text='<%$ Resources:Content, GN00001034 %>' Value="3"></asp:ListItem>
                                                <asp:ListItem Text='<%$ Resources:Content, GN00001035 %>' Value="4"></asp:ListItem>
                                                <asp:ListItem Text='<%$ Resources:Content, GN00001036 %>' Value="5"></asp:ListItem>
                                                <asp:ListItem Text='<%$ Resources:Content, GN00001037 %>' Value="6"></asp:ListItem>
                                                <asp:ListItem Text='<%$ Resources:Content, GN00001038 %>' Value="7"></asp:ListItem>
                                                <asp:ListItem Text='<%$ Resources:Content, GN00001039 %>' Value="8"></asp:ListItem>
                                                <asp:ListItem Text='<%$ Resources:Content, GN00001040 %>' Value="9"></asp:ListItem>
                                                <asp:ListItem Text='<%$ Resources:Content, GN00001041 %>' Value="10"></asp:ListItem>
                                                <asp:ListItem Text='<%$ Resources:Content, GN00001042 %>' Value="11"></asp:ListItem>
                                                <asp:ListItem Text='<%$ Resources:Content, GN00001043 %>' Value="12"></asp:ListItem>
                                            </asp:DropDownList>
                                        </div>
                                    </div>
                                </div>
                                <div class="row">
                                    <div class="col-sm-3 col-xs-12 row-label">
                                        <label>
                                            *<asp:Literal ID="Div9" runat="server" Text='<%$ Resources:Content, GN0000873 %>'
                                                EnableViewState="false" />:</label>
                                    </div>
                                    <div class="col-sm-4 col-xs-12">
                                        <div class="form-group">
                                            <div class="form-line">
                                                <cc1:FilteredTextBoxExtender ID="FilteredTextBoxExtender1" runat="server" TargetControlID="TxBx_Cvv2"
                                                    FilterType="Numbers">
                                                </cc1:FilteredTextBoxExtender>
                                                <asp:TextBox ID="TxBx_Cvv2" MaxLength="4" runat="server"></asp:TextBox>
                                                <asp:RequiredFieldValidator ID="RequiredFieldValidator5" runat="server" Display="None"
                                                    SetFocusOnError="True" ControlToValidate="TxBx_Cvv2" ValidationGroup="addcard"></asp:RequiredFieldValidator>
                                            </div>
                                        </div>
                                    </div>
                                    <div class="col-sm-5 col-xs-12">
                                        <ul class="option-menu">
                                            <li class="dropdown">
                                                <a href="javascript:void(0);" class="dropdown-toggle" data-toggle="dropdown" role="button" aria-haspopup="true" aria-expanded="false">
                                                    <i class="material-icons">help_outline</i>
                                                </a>
                                                <ul class="dropdown-menu pull-right">
                                                    <li>
                                                        <asp:Literal ID="Literal35" runat="server" Text="<%$Resources:Content,GN00008015%>"
                                                            EnableViewState="false"></asp:Literal>
                                                        <b>
                                                            <asp:Literal ID="Literal36" runat="server" Text="<%$Resources:Content,GN00008016%>"
                                                                EnableViewState="false"></asp:Literal>
                                                        </b>
                                                        <asp:Literal ID="Literal3711" runat="server" Text="<%$Resources:Content,GN00008017%>"
                                                            EnableViewState="false"></asp:Literal>
                                                        <b>
                                                            <asp:Literal ID="Literal38" runat="server" Text="<%$Resources:Content,GN00008018%>"
                                                                EnableViewState="false"></asp:Literal>
                                                        </b>
                                                        <asp:Literal ID="Literal39" runat="server" Text="<%$Resources:Content,GN00008019%>"
                                                            EnableViewState="false"></asp:Literal>.
                                                    </li>
                                                    <li>
                                                        <br />
                                                        <asp:Literal ID="Literal32" runat="server" Text="<%$Resources:Content,GN00001029%>"
                                                            EnableViewState="false"></asp:Literal>
                                                        <b>
                                                            <asp:Literal ID="Literal33" runat="server" Text="<%$Resources:Content,GN00001386%>"
                                                                EnableViewState="false"></asp:Literal>
                                                        </b>
                                                        <asp:Literal ID="Literal34" runat="server" Text="<%$Resources:Content,GN00008020%>"
                                                            EnableViewState="false"></asp:Literal>.                                                
                                                    </li>
                                                </ul>
                                            </li>
                                        </ul>
                                    </div>
                                </div>
                                <div class="row">
                                    <div class="col-sm-3 col-xs-12 row-label">
                                        <label>
                                            <asp:Literal ID="Div10" runat="server" Text='<%$ Resources:Content, GN0000874 %>'
                                                EnableViewState="false" />:</label>
                                    </div>
                                    <div class="col-sm-4 col-xs-12">
                                        <div class="form-group">
                                            <div class="form-line">
                                                <asp:TextBox ID="TxBx_Solo" runat="server" MaxLength="50"></asp:TextBox>
                                            </div>
                                        </div>
                                    </div>
                                </div>
                                <div class="row">
                                    <div class="col-sm-3 col-xs-12 row-label">
                                        <label>
                                            <asp:Literal ID="Div11" runat="server" Text='<%$ Resources:Content, GN0000876 %>'
                                                EnableViewState="false" />:</label>
                                    </div>
                                    <div class="col-sm-4 col-xs-12">
                                        <div class="form-group">
                                            <asp:DropDownList ID="DDL_AllowPayment" runat="server">
                                                <asp:ListItem Text='<%$ Resources:Content, GN0000004 %>' Value="1"></asp:ListItem>
                                                <asp:ListItem Text='<%$ Resources:Content, GN0000005 %>' Value="0"></asp:ListItem>
                                            </asp:DropDownList>
                                        </div>
                                    </div>
                                </div>
                                <div class="row">
                                    <div class="col-sm-3 col-xs-12 row-label">
                                        <label>
                                            <asp:Literal ID="Div12" runat="server" Text='<%$ Resources:Content, GN0000892 %>'
                                                EnableViewState="false" />:</label>
                                    </div>
                                    <div class="col-sm-4 col-xs-12">
                                        <div class="form-group">
                                            <asp:DropDownList ID="DDL_UseForRecurring" runat="server">
                                                <asp:ListItem Text='<%$ Resources:Content, GN0000004 %>' Value="1"></asp:ListItem>
                                                <asp:ListItem Text='<%$ Resources:Content, GN0000005 %>' Value="0"></asp:ListItem>
                                            </asp:DropDownList>
                                        </div>
                                    </div>
                                </div>
                            </div>
                        </div>
                    </div>
                    <div class="col-xs-12">
                        <div class="card">
                            <div class="header">
                                <h3>
                                    <asp:Literal ID="Div13" runat="server" Text='<%$ Resources:Content, GN0000877 %>' EnableViewState="false" />
                                </h3>
                            </div>
                            <div class="body">
                                <div class="row">
                                    <div class="col-sm-3 col-xs-12 row-label">
                                        <label>
                                            *<asp:Literal ID="Div14" runat="server" Text='<%$ Resources:Content, GN0000878 %>'
                                                EnableViewState="false" />:</label>
                                    </div>
                                    <div class="col-sm-4 col-xs-12">
                                        <div class="form-group">
                                            <div class="form-line">
                                                <asp:TextBox ID="TxBx_Address" runat="server" MaxLength="60"></asp:TextBox>
                                                <asp:RequiredFieldValidator ID="RequiredFieldValidator6" runat="server" Display="None"
                                                    SetFocusOnError="True" ControlToValidate="TxBx_Address" ValidationGroup="addcard"></asp:RequiredFieldValidator>
                                            </div>
                                        </div>
                                    </div>
                                </div>
                                <div class="row">
                                    <div class="col-sm-3 col-xs-12 row-label">
                                        <label>
                                            <asp:Literal ID="Div15" runat="server" Text='<%$ Resources:Content, GN00001136 %>'
                                                EnableViewState="false" />:</label>
                                    </div>
                                    <div class="col-sm-4 col-xs-12">
                                        <div class="form-group">
                                            <div class="form-line">
                                                <asp:TextBox ID="TxBx_Address2" runat="server" MaxLength="60"></asp:TextBox>
                                                <%--<asp:RequiredFieldValidator ID="RequiredFieldValidator3" runat="server" Display="None"
                                    SetFocusOnError="True" ControlToValidate="TxBx_Address2" ValidationGroup="addcard"></asp:RequiredFieldValidator>--%>
                                            </div>
                                        </div>
                                    </div>
                                </div>
                                <div class="row">
                                    <div class="col-sm-3 col-xs-12 row-label">
                                        <label>
                                            *<asp:Literal ID="Div16" runat="server" Text='<%$ Resources:Content, GN0000880 %>'
                                                EnableViewState="false" />:</label>
                                    </div>
                                    <div class="col-sm-4 col-xs-12">
                                        <div class="form-group">
                                            <div class="form-line">
                                                <asp:TextBox ID="TxBx_City" runat="server" MaxLength="60"></asp:TextBox>
                                                <asp:RequiredFieldValidator ID="RequiredFieldValidator7" runat="server" Display="None"
                                                    SetFocusOnError="True" ControlToValidate="TxBx_City" ValidationGroup="addcard"></asp:RequiredFieldValidator>
                                            </div>
                                        </div>
                                    </div>
                                </div>
                                <div class="row" id="TR_State" runat="server">
                                    <div class="col-sm-3 col-xs-12 row-label">
                                        <label>
                                            <asp:Literal ID="Literal48" runat="server" Text="<%$ Resources:Content,DEV1130%>"
                                                EnableViewState="false" />:</label>
                                    </div>
                                    <div class="col-sm-4 col-xs-12">
                                        <div class="form-group">
                                            <asp:DropDownList ID="DDL_States" runat="server">
                                            </asp:DropDownList>
                                        </div>
                                    </div>
                                </div>
                                <div class="row" id="TR_Province" runat="server">
                                    <div class="col-sm-3 col-xs-12 row-label">
                                        <label>
                                            *<asp:Literal ID="Literal49" runat="server" Text="<%$ Resources:Content,GN00001313%>"
                                                EnableViewState="false" />:</label>
                                    </div>
                                    <div class="col-sm-4 col-xs-12">
                                        <div class="form-group">
                                            <div class="form-line">
                                                <asp:TextBox ID="TxBx_Province" runat="server" MaxLength="60"></asp:TextBox>
                                                <asp:RequiredFieldValidator ID="RFV_Province" runat="server" ControlToValidate="TxBx_Province"
                                                    Display="None" SetFocusOnError="True" ValidationGroup="addcard"></asp:RequiredFieldValidator>
                                            </div>
                                        </div>
                                    </div>
                                </div>
                                <div class="row">
                                    <div class="col-sm-3 col-xs-12 row-label">
                                        <label>
                                            <asp:Literal ID="Div18" runat="server" Text='<%$ Resources:Content, GN0000882 %>'
                                                EnableViewState="false" />:</label>
                                    </div>
                                    <div class="col-sm-4 col-xs-12">
                                        <div class="form-group">
                                            <asp:DropDownList ID="DDL_Countries" AutoPostBack="true" runat="server">
                                            </asp:DropDownList>
                                        </div>
                                    </div>
                                </div>
                                <div class="row">
                                    <div class="col-sm-3 col-xs-12 row-label">
                                        <label>
                                            *<asp:Literal ID="Div19" runat="server" Text='<%$ Resources:Content, GN00001522 %>'
                                                EnableViewState="false" />:</label>
                                    </div>
                                    <div class="col-sm-4 col-xs-12">
                                        <div class="form-group">
                                            <div class="form-line">
                                                <asp:TextBox ID="TxBx_Zip" runat="server" MaxLength="10"></asp:TextBox>
                                                <asp:RequiredFieldValidator ID="RequiredFieldValidator8" runat="server" Display="None"
                                                    SetFocusOnError="True" ControlToValidate="TxBx_Zip" ValidationGroup="addcard"></asp:RequiredFieldValidator>
                                                <cc1:FilteredTextBoxExtender ID="FilteredTextBoxExtender4" runat="server" TargetControlID="TxBx_Zip"
                                                    FilterType="UppercaseLetters,Numbers,LowercaseLetters,Custom" ValidChars="- ">
                                                </cc1:FilteredTextBoxExtender>
                                            </div>
                                        </div>
                                    </div>
                                </div>
                                <div class="row">
                                    <div class="col-sm-3 col-xs-12 row-label">
                                        <label>*<asp:Literal ID="Div20" runat="server" Text='<%$ Resources:Content, GN00012 %>' EnableViewState="false" />:</label>
                                    </div>
                                    <div class="col-sm-4 col-xs-12">
                                        <div class="form-group">
                                            <div class="form-line">
                                                <asp:TextBox ID="TxBx_Phone" runat="server" MaxLength="20"></asp:TextBox>
                                                <asp:RequiredFieldValidator ID="RequiredFieldValidator9" runat="server" Display="None"
                                                    SetFocusOnError="True" ControlToValidate="TxBx_Phone" ValidationGroup="addcard"></asp:RequiredFieldValidator>
                                                <asp:RegularExpressionValidator ErrorMessage='<%$ Resources:Content,DGN1110070%>'
                                                    ID="RegularExpressionValidator2" runat="server" ControlToValidate="TxBx_Phone"
                                                    Display="None" SetFocusOnError="True" ValidationExpression="^([+]?[\s0-9()-]{5,20})$"
                                                    ValidationGroup="addcard"></asp:RegularExpressionValidator>
                                                <%--<cc1:FilteredTextBoxExtender ID="FilteredTextBoxExtender5" runat="server" TargetControlID="TxBx_Phone"
                                    FilterType="Numbers">
                                </cc1:FilteredTextBoxExtender>--%>
                                            </div>
                                        </div>
                                    </div>
                                </div>
                                <div class="row">
                                    <div class="col-sm-3 col-xs-12 row-label">
                                        <label>
                                            <asp:Literal ID="Div21" runat="server" Text='<%$ Resources:Content, GN0000885 %>'
                                                EnableViewState="false" />:</label>
                                    </div>
                                    <div class="col-sm-4 col-xs-12">
                                        <div class="form-group">
                                            <div class="form-line">
                                                <asp:TextBox ID="TxBx_MobilePhone" runat="server" MaxLength="20"></asp:TextBox>
                                                <cc1:FilteredTextBoxExtender ID="FilteredTextBoxExtender7" runat="server" TargetControlID="TxBx_MobilePhone"
                                                    FilterType="Numbers,Custom" ValidChars="+ - ( ) \s">
                                                </cc1:FilteredTextBoxExtender>
                                            </div>
                                        </div>
                                    </div>
                                </div>
                                <div class="row">
                                    <div class="col-sm-3 col-xs-12 row-label">
                                        <label>
                                            <asp:Literal ID="Div22" runat="server" Text='<%$ Resources:Content, GN0000886 %>'
                                                EnableViewState="false" />:</label>
                                    </div>
                                    <div class="col-sm-4 col-xs-12">
                                        <div class="form-group">
                                            <div class="form-line">
                                                <asp:TextBox ID="TxBx_Fax" runat="server" MaxLength="15"></asp:TextBox>
                                                <cc1:FilteredTextBoxExtender ID="FilteredTextBoxExtender6" runat="server" TargetControlID="TxBx_Fax"
                                                    FilterType="Numbers,Custom" ValidChars="+-() ">
                                                </cc1:FilteredTextBoxExtender>
                                            </div>
                                        </div>
                                    </div>
                                </div>
                                <div class="row">
                                    <div class="col-sm-3 col-xs-12 row-label">
                                        <label>
                                            *<asp:Literal ID="Div23" runat="server" Text='<%$ Resources:Content, GN0000652 %>'
                                                EnableViewState="false" />:</label>
                                    </div>
                                    <div class="col-sm-4 col-xs-12">
                                        <div class="form-group">
                                            <div class="form-line">
                                                <asp:TextBox ID="TxBx_Email" runat="server" MaxLength="64"></asp:TextBox>
                                                <%--<asp:RegularExpressionValidator ErrorMessage='<%$ Resources:Content, DGN1110038 %>'
                                                    ID="RegularExpressionValidator1" runat="server" ControlToValidate="TxBx_Email"
                                                    Display="None" SetFocusOnError="True" ValidationExpression="<%$ Resources:MPRegex,EmailAddress %>"
                                                    ValidationGroup="addcard"></asp:RegularExpressionValidator>--%>
                                                <asp:RequiredFieldValidator ID="RequiredFieldValidator10" runat="server" Display="None"
                                                    SetFocusOnError="True" ControlToValidate="TxBx_Email" ValidationGroup="addcard"></asp:RequiredFieldValidator>
                                            </div>
                                        </div>
                                    </div>
                                </div>
                                <div class="row">
                                    <div class="col-xs-12">
                                        <asp:ValidationSummary HeaderText='<%$ Resources:Content, EM000001 %>' ID="ValidationSummary1"
                                            runat="server" ShowMessageBox="True" ShowSummary="False" ValidationGroup="addcard" />

                                        <asp:Button ID="Btn_Add" runat="server" Text='<%$ Resources:Content, GN0000281 %>'
                                            class="btn btn-primary waves-effect" ValidationGroup="addcard" />
                                        <asp:Button ID="Btn_Cancel" runat="server" Text='<%$ Resources:Content, GN0000572 %>'
                                            class="btn btn-primary waves-effect" CausesValidation="False" />
                                    </div>
                                </div>
                            </div>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </asp:Panel>
</asp:Content>
