kuzafront/payment.html at master · DevlessTeam/kuzafront · GitHub

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<!DOCTYPE html>
<html lang="en">
<head>
	<meta charset="UTF-8">
	<meta name="viewport" content="width=device-width, initial-scale=1" />
	<title>Kuza Forms - Sell Anywhere, Grow your Business</title>
	<link rel="stylesheet" href="css/bootstrap.min.css">
	<link rel="stylesheet" href="css/custom.css">

	<style>
</style>
</head>
<body>
	<div class="container">
		<form action="index.html" method="POST" role="form" class="singleWrap">
			<div class="w-100">
				<div class="row pd-30">
					<div class="col-lg-4 col-lg-offset-4 col-md-6 col-md-offset-3 col-sm-8 col-sm-offset-2 payCont">
						<h3 class="text-center">Make Payment</h3>
						<hr>
						<div class="row text-center payLogo">
							<div class="col-xs-4"><img class="img-responsive" src="images/mtn_m.jpg" alt=""></div>
							<div class="col-xs-4"><img class="img-responsive" src="images/tigo_m.jpg" alt=""></div>
							<div class="col-xs-4"><img class="img-responsive" src="images/airtel_m.jpg" alt=""></div>
						</div>
						<div class="row mr-t-30">
							<div class="form-group col-md-12">
								<select class="form-control" required="required">
									<option value="">Select Mobile Wallet</option>
									<option value="">MTN Mobile Money</option>
									<option value="">Tigo Cash</option>
									<option value="">Airtel Money</option>
								</select>
							</div>
							<div class="form-group col-md-12">
								<label for="" class="control-label">Wallet #</label>
								<input type="text" class="form-control" id="" placeholder="Enter your Wallet Number">
							</div>
							<div class="form-group col-md-12 mr-t-20 text-center mr-b-0">
								<button type="submit" class="btn btn-primary">Make Payment</button>
							</div>
						</div>
					</div>
				</div>
			</div>
		</form>
	</div>
</body>
</html>