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Code Editor : giveback.php
<!DOCTYPE html> <html> <head> <title>Alumni | Give Back</title> <link rel="stylesheet" href="css-ag/bootstrap.min.css"> <link rel="stylesheet" href="css-ag/stylesheet.css"> <link href='http://fonts.googleapis.com/css?family=Droid+Sans' rel='stylesheet' type='text/css'> <style> body { font-family: "Droid Sans", "Helvetica Neue", Helvetica, Arial, sans-serif !important; } </style> </head> <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 class="glyphicon glyphicon-home"><span class="nav-bar-font">Home</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 style="text-align: center">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;"> <div> <h3>Contributor's Information</h3> <div class="form-group input-group pull-left" id="field.auto_id" style="width: 400px;margin-right: 15px;"> <span class="input-group-addon" style="width: 90px;">First Name</span> <input type="text" name="FName" class="form-control" required/> </div> <div class="form-group input-group pull-left" id="field.auto_id" style="width: 400px;margin-right: 15px;"> <span class="input-group-addon" style="width: 90px;">Last Name</span> <input type="text" name="LName" class="form-control" required/> </div> <div class="form-group input-group" id="field.auto_id" style="width: 225px;"> <span class="input-group-addon" style="width: 90px;">MI</span> <input type="text" name="MI" class="form-control"/> </div> <div class="form-group input-group" id="field.auto_id" style="width: 705px;"> <span class="input-group-addon" style="width: 90px;">Address</span> <input name="fulladress" type="text" class="form-control" required/> </div> <div class="form-group input-group pull-left" id="field.auto_id" style="width: 400px;margin-right: 15px;"> <span class="input-group-addon" style="width: 90px;">City</span> <input type="text" name="city" class="form-control" required/> </div> <div class="form-group input-group pull-left" id="field.auto_id" style="width: 400px;margin-right: 15px;"> <span class="input-group-addon" style="width: 90px;">State</span> <input type="text" name="state" class="form-control" required/> </div> <div class="form-group input-group" id="field.auto_id" style="width: 225px;"> <span class="input-group-addon" style="width: 90px;">Pincode</span> <input type="text" name="Pincode" max="6" class="form-control" required/> </div> <div class="form-group input-group pull-left" id="field.auto_id" style="width: 400px;margin-right: 15px;"> <span class="input-group-addon" style="width: 90px;">Telephone</span> <input type="tel" name="Mobile" id="Mobile" required max="13" placeholder="Digits only" onBlur="check();" class="form-control"/> </div> <div class="form-group input-group pull-left" id="field.auto_id" style="width: 400px;margin-right: 15px;"> <span class="input-group-addon" style="width: 90px;">Email</span> <input type="email" name="Email" class="form-control" required/> </div> <div class="form-group input-group" id="field.auto_id" style="width: 225px;"> <span class="input-group-addon" style="width: 90px;">PAN</span> <input type="text" name="PAN" max="10" class="form-control" required/> </div> <div class="form-group input-group" id="field.auto_id" style="width: 705px;"> <span class="input-group-addon"><input type="checkbox" name="anonymous" onClick="form.remark.value += 'Donation as Anonymous'"/></span> <span class="form-control">I (we) wish to have my (our) donation remain anonymous.</span> </div> </div> <div class="divider-4r" style="margin: 40px 0 30px 0px;padding:0;width: 705px;"></div> <div> <h3>Donation Information</h3> <p>I pledge to contribute towards</p> <div class="form-group input-group" id="field.auto_id" style="width: 705px;"> <span class="input-group-addon"><input type="radio" name="contribiute" value=" Scholarships" checked="checked" onClick="form.remark.value = this.value"/></span> <span class="form-control">Scholarships for students for financially weaker sections</span> </div> <div class="form-group input-group" id="field.auto_id" style="width: 705px;"> <span class="input-group-addon"><input type="radio" name="contribiute" value=" travelgrants" onClick="form.remark.value = this.value"/></span> <span class="form-control">Travel Grants for students for International Conferences</span> </div> <div class="form-group input-group" id="field.auto_id" style="width: 705px;"> <span class="input-group-addon"><input type="radio" name="contribiute" value=" studentclub" onClick="form.remark.value = this.value"/></span> <span class="form-control">Student Clubs and Activities</span> </div> <div class="form-group input-group" id="field.auto_id" style="width: 705px;"> <span class="input-group-addon"><input type="radio" name="contribiute" value=" Entrepreneurship" onClick="form.remark.value = this.value"/></span> <span class="form-control">Entrepreneurship Activities</span> </div> <div class="form-group input-group" id="field.auto_id" style="width: 705px;"> <span class="input-group-addon"><input type="radio" name="contribiute" value=" Teaching" onClick="form.remark.value = this.value"/></span> <span class="form-control">Teaching Excellence Awards</span> </div> <div class="form-group input-group" id="field.auto_id" style="width: 710px;"> <span class="input-group-addon"><input type="radio" name="contribiute" value=" Other" onClick="form.remark.value = this.value"/></span> <span class="form-control pull-left" style="width: 200px;">Others (Please Specify)</span> <input type="text" name="OtherOption" class="form-control" style="width: 467px;" onChange="form.remark.value = this.value"/> </div> <p>Donation Frequency</p> <div class="form-group input-group pull-left" id="field.auto_id" style="width: 345px;margin-right: 15px;"> <span class="input-group-addon"><input type="radio" name="doationfrequency" value="one time" checked="checked" onClick="showblock(onetime);hideblock(repeating);twentyfive.checked='checked';form.tamount.value ='25000.00';"/></span> <span class="form-control">One-time donation of INR</span> </div> <div class="form-group input-group" id="field.auto_id" style="width: 345px;"> <span class="input-group-addon"><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';"/></span> <span class="form-control">Repeating donation of INR</span> </div> <p>Donation Amount</p> <div id="onetime"> <div class="form-group input-group pull-left" id="field.auto_id" style="width: 115px;margin-right: 15px;"> <span class="input-group-addon"><input type="radio" name="donation" value="100000.00" onClick="form.tamount.value = this.value;"/></span> <span class="form-control">100,000</span> </div> <div class="form-group input-group pull-left" id="field.auto_id" style="width: 105px;margin-right: 15px;"> <span class="input-group-addon"><input type="radio" name="donation" value="75000.00" onClick="form.tamount.value = this.value;"/></span> <span class="form-control">75,000</span> </div> <div class="form-group input-group pull-left" id="field.auto_id" style="width: 105px;margin-right: 15px;"> <span class="input-group-addon"><input type="radio" name="donation" value="50000.00" onClick="form.tamount.value = this.value;"/></span> <span class="form-control">50,000</span> </div> <div class="form-group input-group pull-left" id="field.auto_id" style="width: 105px;margin-right: 15px;"> <span class="input-group-addon"><input type="radio" name="donation" id="twentyfive" value="25000.00" checked="checked" onClick="form.tamount.value = this.value;"/></span> <span class="form-control">25,000</span> </div> <div class="form-group input-group" id="field.auto_id" style="width: 210px;"> <span class="input-group-addon"><input type="radio" name="donation" value="Other" onClick="form.tamount.value = form.other.value;"/></span> <span class="form-control pull-left" style="width: 70px;">Other</span> <input type="text" name="other" id="other" onBlur="form.tamount.value = this.value;checkother();" placeholder="Digits only" class="form-control" style="width: 100px;"/> </div> </div> <div id="repeating" style="display: none;"> <div class="form-group input-group pull-left" id="field.auto_id" style="width: 115px;margin-right: 15px;"> <span class="input-group-addon"><input type="radio" name="donation" value="50000.00" onClick="form.tamount.value = this.value;"/></span> <span class="form-control">50,000</span> </div> <div class="form-group input-group pull-left" id="field.auto_id" style="width: 105px;margin-right: 15px;"> <span class="input-group-addon"> <input type="radio" name="donation" value="40000.00" onClick="form.tamount.value = this.value;"/> </span> <span class="form-control">40,000</span> </div> <div class="form-group input-group pull-left" id="field.auto_id" style="width: 105px;margin-right: 15px;"> <span class="input-group-addon"> <input type="radio" name="donation" value="20000.00" onClick="form.tamount.value = this.value;"/> </span> <span class="form-control">20,000</span> </div> <div class="form-group input-group pull-left" id="field.auto_id" style="width: 105px;margin-right: 15px;"> <span class="input-group-addon"> <input type="radio" id="ten" name="donation" value="10000.00" onClick="form.tamount.value = this.value;"/> </span> <span class="form-control">10,000</span> </div> <div class="form-group input-group" id="field.auto_id" style="width: 210px;"> <span class="input-group-addon"> <input type="radio" name="donation" value="Other" onClick="form.tamount.value = form.Rother.value;"/> </span> <span class="form-control pull-left" style="width: 70px;">Other</span> <input type="text" name="rother" id="rother" value="" onBlur="form.tamount.value = this.value;checkrother();" placeholder="Digits only" class="form-control" style="width: 100px;"/> </div> </div> <p>Payment Method</p> <div class="form-group input-group pull-left" id="field.auto_id" style="width: 235px;margin-right: 15px"> <span class="input-group-addon"> <input type="radio" name="regtype" value="Donate Now" checked="checked" onClick="showblock(paymentmethod);this.form.action='donatehdfc.php';form.paynow.value = ' Donate Now ';"/> </span> <span class="form-control"> I would like to pay now </span> </div> <div class="form-group input-group" id="field.auto_id" style="width: 455px;"> <span class="input-group-addon"> <input type="radio" name="regtype" value="Donate Later" onClick="hideblock(paymentmethod);this.form.action='donationmail.php';form.paynow.value = ' Donate Later ';"/> </span> <span class="form-control"> I would like to pay later, please contact me by email / phone </span> </div> <div id="paymentmethod"> <div class="form-group input-group pull-left" id="field.auto_id" style="width: 235px;margin-right: 15px"> <span class="input-group-addon"> <input type="radio" value="hdfc" name="paymenttype" checked required onClick="this.form.action='donatehdfc.php'"/> </span> <span class="form-control"> Via Credit Card </span> </div> <div class="form-group input-group" id="field.auto_id" style="width: 455px;"> <span class="input-group-addon"> <input name="paymenttype" type="radio" value="billdesk" required onClick="this.form.action='donatebilldesk.php'"> </span> <span class="form-control"> Via Bank Transfer (only for Banks within India) </span> </div> </div> <div class="form-group input-group" id="field.auto_id" style="width:705px;"> <span class="input-group-addon">Total Donation Amount</span> <input type="text" value="25000.00" name="tamount" class="form-control" style="border-radius: 0 5px 5px 0" readonly /> <input type="hidden" value="" name="remark" readonly width="353px" class="form-control"/> </div> </div> <div class="divider-4r" style="margin: 40px 0 30px 0px;padding:0;width: 705px;"></div> <div style="width: 705px;"> <h3 style="margin-top: 30px">Note</h3> <ul style="margin: 10px 0 0 20px;padding: 0;" class="normal-list"> <li> We will send you the information required for payment by email. </li> <li> IIITD 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> </div> <div style="margin: 30px 0 0 0;text-align: center"> <input name="MTrackid" size="25" value="90002954" type="hidden"/> <input type="submit" name="paynow" value=" DONATE NOW " class="btn btn-warning"/> </div> </form> </div> </div> <div class="col-lg-3"> <div class="row"> <h3>Faculty Coordinator</h3> </div> <div class="row"> <div class="panel panel-default"> <div class="panel-heading h4-big" style="height:100px;"> <img src="http://alumni.iiitd.edu.in/static/alumniportal/img/richasingh.jpg" class="img-circle pull-right" style="height:80px;width:80px;top:0;left:0;border:1px #ccc solid"> <h4 class="panel-user-h4 h4-big"><a href="http://www.iiitd.edu.in/~richa/">Richa Singh</a></h4> <p>Assistant Professor</p> </div> <div class="panel-body text-left" style="display: block;"> <span class="glyphicon glyphicon-phone card-field"><span class="card-field-font">+91-11-26907433</span></span><br/> <span class="glyphicon glyphicon-map-marker card-field"><span class="card-field-font">A-201, IIITD</span></span><br/> <span class="glyphicon glyphicon-inbox card-field"><span class="card-field-font">rsingh@iiitd.ac.in</span></span><br/> <div class="clearfix"></div> </div> </div> </div> </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"> </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"); } } function checkother() { var m = document.getElementById('other').value; if (isNaN(m)) { alert(m + " is not a valid number"); document.getElementById('other').value = ''; } } function checkrother() { var m = document.getElementById('rother').value; if (isNaN(m)) { alert(m + " is not a valid number"); } } </script> </body> </html>
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