{% extends 'crm/base.html' %} {% load static %} {% block title %} Make Payment {% endblock title %} {% block body %}

Make Payment

{% csrf_token %}

Billing Details

{% include 'crm/fragments/form_field.inc.html' with field=form.billing_name %} {% include 'crm/fragments/form_field.inc.html' with field=form.address_line1 %} {% include 'crm/fragments/form_field.inc.html' with field=form.address_line2 %} {% include 'crm/fragments/form_field.inc.html' with field=form.address_city %} {% include 'crm/fragments/form_field.inc.html' with field=form.address_state %} {% include 'crm/fragments/form_field.inc.html' with field=form.address_zip %} {% include 'crm/fragments/form_field.inc.html' with field=form.address_country %}

Payment Details

{{ payment_error }}

{% include 'crm/fragments/form_field.inc.html' with field=form.fullname %} {% include 'crm/fragments/form_field.inc.html' with field=form.card_number %} {% include 'crm/fragments/form_field.inc.html' with field=form.expiration %} {% include 'crm/fragments/form_field.inc.html' with field=form.cvc %}

${{amount}}

{% endblock body %} {{% block extra_js %} {% endblock %}