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Code Editor : giveback.php
<!DOCTYPE html> <html> <head> <title>Alumni | Give Back</title> <link rel="stylesheet" href="http://alumni.iiitd.edu.in/static/bootstrap/css/bootstrap.min.css"> <link rel="stylesheet" href="http://alumni.iiitd.edu.in/static/alumniportal/css/stylesheet.css"> </head> <style type="text/css"> input{ border:1px solid #777777; margin: 10px 0 0;vertical-align: middle;} </style> <body> <!-- Main Element for Full width --> <div id="nav-bar-main" class="row navbar-fixed-top"> <div class="container"> <!-- Element for actual navbar --> <div class="row"> <div class="pull-left"> <a href="/"><img src="http://alumni.iiitd.edu.in/static/alumniportal/img/alumni-logo.png" style="height:50px;margin-top:15px;"/></a> </div> <div id="nav-bar" class="pull-right"> <ul> <a href="http://alumni.iiitd.edu.in/"><li ><span class="nav-bar-font">Home</span></li></a> <a href="http://alumni.iiitd.edu.in/news/"><li ><span class="nav-bar-font">News</span></li></a> <a href="http://alumni.iiitd.edu.in/blog/"><li ><span class="nav-bar-font">Blog</span></li></a> <a href="http://alumni.iiitd.edu.in/directory/"><li ><span class="nav-bar-font">Directory</span></li></a> <a href="http://alumni.iiitd.edu.in/giveback/"><li ><span class="nav-bar-font">Give Back</span></li></a> <a href="http://alumni.iiitd.edu.in/contact_us/"><li ><span class="nav-bar-font">Contact Us</span></li></a> </ul> </div> </div> </div> </div> <div class="container"> <div class="row"> <div class="col-lg-offset-1 col-lg-10" id="green-dabba"></div> </div> <div id="contentpane" class="row"> <div class="card-main col-lg-9"> <div class="row no-underline"> <h2>Donation Pledge Form</h2> <FORM name='form' action='donatehdfc.php' method='post' encType= 'multipart/form-data' onSubmit="form.paynow.value='Submitting.. ';form.paynow.disable=true;" > <table border="0" align="center" cellspacing="5" cellpadding="2" width="100%"> <TBODY> <tr><td colspan="6"><h3>CONTRIBUTOR'S INFORMATION</h3></td></tr> <tr> <td width="10%">Last Name</td> <td width="24%"> <input type="text" name="LName" required /></td> <td width="10%" > First Name </td> <td width="18%"> <input type="text" name="FName" required /></td> <td width="9%" align="center"> MI</td> <td width="29%"> <input type="text" name="MI" /></td> </tr> <tr> <td > Address </td><td colspan="5"> <input name="fulladress" type="text" size="89%" required /></td> </tr> <tr> <td> City</td> <td> <input type="text" name="city" required /></td> <td > State</td> <td> <input type="text" name="state" required /></td> <td align="center"> Pincode</td> <td> <input type="text" name="Pincode" max="6" required /></td> </tr> <tr> <td> Telephone</td> <td> <input type="tel" name="Mobile" required max="13" placeholder="digits only" onBlur="check();" /></td> <td > Email</td> <td> <input type="email" name="Email" required /></td> <td align="center"> PAN </td> <td> <input type="text" name="PAN" max="10" required /></td> </tr> <tr> <td> <input type="checkbox" name="anonymous" onClick="form.remark.value += 'Donation as Anonymous'" /></td> <td colspan="5">I (we) wish to have my (our) donation remain anonymous.</td> </tr> <tr> <td colspan="6"><br /></td> </tr> <tr> <td colspan="6"><h3>DONATION INFORMATION</h3></td> </tr> <tr> <td colspan="6"> I pledge to contribute towards: </td></tr> <tr> <td> <input type="radio" name="contribiute" value=" Scholarships" checked="checked" onClick="form.remark.value = this.value" /></td><td colspan="5">Scholarships for students for financially weaker sections</td> </tr> <tr><td> <input type="radio" name="contribiute" value=" travelgrants" onClick="form.remark.value = this.value" /></td><td colspan="5">Travel Grants for students for International Conferences</td></tr> <tr><td> <input type="radio" name="contribiute" value=" studentclub" onClick="form.remark.value = this.value" /></td><td colspan="5">Student Clubs and Activities</td> </tr> <tr><td> <input type="radio" name="contribiute" value=" Entrepreneurship" onClick="form.remark.value = this.value" /></td><td colspan="5">Entrepreneurship Activities</td> </tr> <tr><td> <input type="radio" name="contribiute" value=" Teaching" onClick="form.remark.value = this.value" /></td><td colspan="5">Teaching Excellence Awards</td></tr> <tr><td> <input type="radio" name="contribiute" value=" Other" onClick="form.remark.value = this.value" /></td><td >Others (Please Specify)</td> <td colspan="4" align="left"><input type="text" name="OtherOption" onChange="form.remark.value = this.value" placeholder="digits only" onBlur="check();" /></td></tr> </tr> <tr> <td colspan="6"><br /></td> </tr> <tr><td colspan="2"> <input type="radio" name="doationfrequency" value="one time" checked="checked" onClick="showblock(onetime);hideblock(repeating);twentyfive.checked='checked';form.tamount.value ='25000.00';" /> One-time donation of INR</td> <td colspan="4"> <input type="radio" name="doationfrequency" value="repeating" onClick="hideblock(onetime);showblock(repeating);form.remark.value+= 'Repeat donation';form.tamount.value ='10000.00';ten.checked='checked';" /> Repeating donation of INR</td></tr> <tr id="onetime"><td> <input type="radio" name="donation" value="100000.00" onClick="form.tamount.value = this.value;" /> 100,000 </td> <td> <input type="radio" name="donation" value="75000.00" onClick="form.tamount.value = this.value;" /> 75,000 </td> <td> <input type="radio" name="donation" value="50000.00" onClick="form.tamount.value = this.value;" /> 50,000 </td> <td> <input type="radio" name="donation" id="twentyfive" value="25000.00" checked="checked" onClick="form.tamount.value = this.value;" /> 25,000 </td> <td> <input type="radio" name="donation" value="Other" onClick="form.tamount.value = form.other.value;" /> Other</td> <td> <input type="text" name="other" onBlur="form.tamount.value = this.value;" placeholder="digits only" onBlur="check();" /></td></tr> <tr id="repeating" style="display:none"><td><input type="radio" name="donation" value="50000.00" onClick="form.tamount.value = this.value;" /> 50,000 </td> <td> <input type="radio" name="donation" value="40000.00" onClick="form.tamount.value = this.value;" /> 40,000 </td> <td> <input type="radio" name="donation" value="20000.00" onClick="form.tamount.value = this.value;" /> 20,000 </td> <td> <input type="radio" id="ten" name="donation" value="10000.00" onClick="form.tamount.value = this.value;" /> 10,000 </td> <td><input type="radio" name="donation" value="Other" onClick="form.tamount.value = form.Rother.value;" /> Other</td> <td><input type="text" name="Rother" value="" onBlur="form.tamount.value = this.value;" /></td></tr> <tr> <td><br /></td> <td colspan="5"></td> </tr> <tr> <td><input type="radio" name="regtype" value="Donate Later" onClick="hideblock(paymentmethod);this.form.action='donationmail.php';form.paynow.value = ' Donate Later ';" /></td> <td colspan="4">I would like to pay later, please contact me by email / phone</td><td> <input type="radio" name="regtype" value="Donate Now" checked="checked" onClick="showblock(paymentmethod);this.form.action='donatehdfc.php';form.paynow.value = ' Donate Later ';" /> I would like to pay now</td> </tr> <tr id="paymentmethod"> <td><input type="radio" value="hdfc" name="paymenttype" checked required onClick="this.form.action='donatehdfc.php'" /></td> <td> Via Credit Card</td> <td><input name="paymenttype" type="radio" value="billdesk" required onClick="this.form.action='donatebilldesk.php'"></td> <td colspan="3"> Via Bank Transfer (only for Banks within India)</td> </tr> <tr> <td colspan="2">Total Donation Amount</td> <td colspan="4"><input type="text" value="25000.00" name="tamount" /> <input type="hidden" value="" name="remark" readonly width="353px" /></td> </tr> <tr> <td colspan="6"><h3>Notes</h3></td> </tr> <tr> <td colspan="6"><ul> <li>IIIT-Delhi urges all alumni to contribute to their alma mater, at least 1% of their yearly income to the Institute.</li> <li>IIITD is registered under section 80G of the Income Tax Act, 1961 that entitles a donor to claim 50% deduction on amount donated to Institute. Upon donation the Institute will issue a receipt mentioning amount donated, approval number, and date etc. for claiming deduction.</li></ul></td> </tr> <tr> <td colspan="6" align="center"><input name="MTrackid" size="25" value="90002954" type="hidden" /> <input type="submit" name="paynow" value=" DONATE NOW " /> </td> </tr> </TBODY> </table> </form> </div> </div> <div class="col-lg-3"> </div> </div> <div class="row"> <div class="col-lg-offset-1 col-lg-10" id="green-dabba-2"></div> </div> <div class="row"> <div class="footer"> <div class="col-lg-4"> <img src="http://alumni.iiitd.edu.in/static/alumniportal/img/Logo.png" width="300" /> </div> <div class="col-lg-8"> <ul> <li><a>Home</a></li> <li><span>|</span></li> <li><a>About Us</a></li> <li><span>|</span></li> <li id="openfeedback"><a>Feedback</a></li> <li><span>|</span></li> <li><a>Contact Us</a></li> </ul> </div> </div> </div> <div id="black"></div> </div> <script type="application/javascript"> function showblock(t){ t.style.display=''; } function hideblock(t){ t.style.display='none'; } function check() { var m = document.getElementById('mobile').value; if(isNaN(m)) { alert (m + " is not a valid number"); } } </script> </body> </html>
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