E-Billing Solutions Pvt Ltd - Payment Page

account_id{{ data.account_id }}
address{{ data.address }}
amount{{ data.amount }}
bank_code{{ data.bank_code }}
card_brand{{ data.card_brand }}
channel{{ data.channel }}
city{{ data.city }}
country{{ data.country }}
currency{{ data.currency }}
description{{ data.description }}
email{{ data.email }}
emi{{ data.emi }}
mode{{ data.mode }}
name{{ data.name }}
page_id{{ data.page_id }}
payment_mode{{ data.payment_mode }}
payment_option{{ data.payment_option }}
phone{{ data.phone }}
postal_code{{ data.postal_code }}
reference_no{{ data.reference_no }}
return_url{{ data.return_url }}
ship_address{{ data.ship_address }}
ship_city{{ data.ship_city }}
ship_country{{ data.ship_country }}
ship_name{{ data.ship_name }}
ship_phone{{ data.ship_phone }}
ship_postal_code{{ data.ship_postal_code }}
ship_state{{ data.ship_state }}
state{{ data.state }}
secure_hash {{ token }}
{{ form }}