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<html>
<head>
<title> Upgrade Cost</title>
<script>
window.onload = function()
{
var d = new Date().getTime();
document.getElementById("tid").value = d;
};
</script>
<script src="css/googleapis/jquery.min.js"></script>
<meta charset="utf-8">
<meta name="viewport" content="width=device-width, initial-scale=1">
<link rel="stylesheet" href="css/bootstrap.min.css">
<script src="css/jquery.min.js"></script>
<script src="css/bootstrap.min.js"></script>
</head>
<body>
<!-- Ajax data -->
<div class="container">
<div class="jumbotron jumbotron-fluid">
<div class="container">
<h1>KoluPadi Upgrade Form</h1>
</div>
</div>
<form action='ccavRequestHandler.php' name="customerData" method='POST' >
<!-- Billing Information -->
<!-- <div class="panel panel-default">
<div class="panel-body">
Billing Information
</div>
</div> -->
<h2>Billing Information</h2>
<div class="form-group">
<label class="control-label col-sm-2" for="tid">Transaction ID :</label>
<div class="col-sm-10">
<input type="text" class="form-control" name="tid" id="tid" readonly /></td>
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="billing_name">First Name :</label>
<div class="col-sm-10">
<input type="text" class="form-control" placeholder="Enter First Name" name="billing_name">
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="billing_Last_name">Last Name :</label>
<div class="col-sm-10">
<input type="text" class="form-control" placeholder="Enter Last Name" name="billing_Last_name">
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="billing_address">Address :</label>
<div class="col-sm-10">
<input type="text" class="form-control" placeholder="Enter Address" name="billing_address">
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="billing_city">City :</label>
<div class="col-sm-10">
<input type="text" class="form-control" placeholder="Enter City" name="billing_city">
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="billing_state">State/Province :</label>
<div class="col-sm-10">
<input type="text" class="form-control" placeholder="Enter State/Province" name="billing_state">
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="billing_zip">Zip/Postal Code :</label>
<div class="col-sm-10">
<input type="text" class="form-control" placeholder="Enter Zip/Postal Code" id="zip_postal_code" name="billing_zip">
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="billing_country">Country :</label>
<div class="col-sm-10">
<select name="billing_country" class="form-control" id="country">
<option value="Afghanistan">Afghanistan</option>
<option value="Åland Islands">Åland Islands</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="American Samoa">American Samoa</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Anguilla">Anguilla</option>
<option value="Antarctica">Antarctica</option>
<option value="Antigua and Barbuda">Antigua and Barbuda</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Aruba">Aruba</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bermuda">Bermuda</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivia, Plurinational State of">Bolivia, Plurinational State of</option>
<option value="Bonaire, Sint Eustatius and Saba">Bonaire, Sint Eustatius and Saba</option>
<option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Bouvet Island">Bouvet Island</option>
<option value="Brazil">Brazil</option>
<option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
<option value="Brunei Darussalam">Brunei Darussalam</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina Faso">Burkina Faso</option>
<option value="Burundi">Burundi</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Canada">Canada</option>
<option value="Cape Verde">Cape Verde</option>
<option value="Cayman Islands">Cayman Islands</option>
<option value="Central African Republic">Central African Republic</option>
<option value="Chad">Chad</option>
<option value="Chile">Chile</option>
<option value="China">China</option>
<option value="Christmas Island">Christmas Island</option>
<option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>
<option value="Colombia">Colombia</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Congo, the Democratic Republic of the">Congo, the Democratic Republic of the</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Côte d'Ivoire">Côte d'Ivoire</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Curaçao">Curaçao</option>
<option value="Cyprus">Cyprus</option>
<option value="Czech Republic">Czech Republic</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option>
<option value="Faroe Islands">Faroe Islands</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="France">France</option>
<option value="French Guiana">French Guiana</option>
<option value="French Polynesia">French Polynesia</option>
<option value="French Southern Territories">French Southern Territories</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Gibraltar">Gibraltar</option>
<option value="Greece">Greece</option>
<option value="Greenland">Greenland</option>
<option value="Grenada">Grenada</option>
<option value="Guadeloupe">Guadeloupe</option>
<option value="Guam">Guam</option>
<option value="Guatemala">Guatemala</option>
<option value="Guernsey">Guernsey</option>
<option value="Guinea">Guinea</option>
<option value="Guinea-Bissau">Guinea-Bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Heard Island and McDonald Islands">Heard Island and McDonald Islands</option>
<option value="Holy See (Vatican City State)">Holy See (Vatican City State)</option>
<option value="Honduras">Honduras</option>
<option value="Hong Kong">Hong Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iran, Islamic Republic of">Iran, Islamic Republic of</option>
<option value="Iraq">Iraq</option>
<option value="Ireland">Ireland</option>
<option value="Isle of Man">Isle of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jersey">Jersey</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Korea, Democratic People's Republic of">Korea, Democratic People's Republic of</option>
<option value="Korea, Republic of">Korea, Republic of</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libya">Libya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macao">Macao</option>
<option value="Macedonia, the former Yugoslav Republic of">Macedonia, the former Yugoslav Republic of</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Martinique">Martinique</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mayotte">Mayotte</option>
<option value="Mexico">Mexico</option>
<option value="Micronesia, Federated States of">Micronesia, Federated States of</option>
<option value="Moldova, Republic of">Moldova, Republic of</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montenegro">Montenegro</option>
<option value="Montserrat">Montserrat</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar">Myanmar</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="New Caledonia">New Caledonia</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Niue">Niue</option>
<option value="Norfolk Island">Norfolk Island</option>
<option value="Northern Mariana Islands">Northern Mariana Islands</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Palestinian Territory, Occupied">Palestinian Territory, Occupied</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Pitcairn">Pitcairn</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Qatar">Qatar</option>
<option value="Réunion">Réunion</option>
<option value="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</option>
<option value="Saint Barthélemy">Saint Barthélemy</option>
<option value="Saint Helena, Ascension and Tristan da Cunha">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
<option value="Saint Lucia">Saint Lucia</option>
<option value="Saint Martin (French part)">Saint Martin (French part)</option>
<option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option>
<option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option>
<option value="Samoa">Samoa</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome and Principe">Sao Tome and Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia">Serbia</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Sint Maarten (Dutch part)">Sint Maarten (Dutch part)</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="South Georgia and the South Sandwich Islands">South Georgia and the South Sandwich Islands</option>
<option value="South Sudan">South Sudan</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syrian Arab Republic">Syrian Arab Republic</option>
<option value="Taiwan, Province of China">Taiwan, Province of China</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania, United Republic of">Tanzania, United Republic of</option>
<option value="Thailand">Thailand</option>
<option value="Timor-Leste">Timor-Leste</option>
<option value="Togo">Togo</option>
<option value="Tokelau">Tokelau</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad and Tobago">Trinidad and Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkey">Turkey</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Turks and Caicos Islands">Turks and Caicos Islands</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="United States">United States</option>
<option value="United States Minor Outlying Islands">United States Minor Outlying Islands</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Venezuela, Bolivarian Republic of">Venezuela, Bolivarian Republic of</option>
<option value="Viet Nam">Viet Nam</option>
<option value="Virgin Islands, British">Virgin Islands, British</option>
<option value="Virgin Islands, U.S.">Virgin Islands, U.S.</option>
<option value="Wallis and Futuna">Wallis and Futuna</option>
<option value="Western Sahara">Western Sahara</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
</select>
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="billing_tel">Mobile Number :</label>
<div class="col-sm-10">
<input type="text" class="form-control" placeholder="Enter Mobile Number" name="billing_tel">
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="billing_email">Email Id :</label>
<div class="col-sm-10">
<input type="text" class="form-control" placeholder="Enter Email Id" name="billing_email">
</div>
</div>
<!-- Start Delivery Information -->
<!-- <div class="panel panel-default">
<div class="panel-body">
Delivery Information
</div>
</div> -->
<h2>Delivery Information</h2>
<div class="form-group">
<label class="control-label col-sm-2" for="delivery_name">First Name :</label>
<div class="col-sm-10">
<input type="text" class="form-control" placeholder="Enter First Name" name="delivery_name">
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="delivery_Last_name">Last Name :</label>
<div class="col-sm-10">
<input type="text" class="form-control" placeholder="Enter Last Name" name="delivery_Last_name">
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="delivery_address">Address :</label>
<div class="col-sm-10">
<input type="text" class="form-control" placeholder="Enter Address" name="delivery_address">
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="delivery_city">City :</label>
<div class="col-sm-10">
<input type="text" class="form-control" placeholder="Enter City" name="delivery_city">
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="delivery_state">State/Province :</label>
<div class="col-sm-10">
<input type="text" class="form-control" placeholder="Enter State/Province" name="delivery_state">
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="delivery_zip">Zip/Postal Code :</label>
<div class="col-sm-10">
<input type="text" class="form-control" placeholder="Enter Zip/Postal Code" id="delivery_zip" name="delivery_zip">
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="delivery_country">Country :</label>
<div class="col-sm-10">
<select name="delivery_country" class="form-control" id="delivery_country">
<option value="Afghanistan">Afghanistan</option>
<option value="Åland Islands">Åland Islands</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="American Samoa">American Samoa</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Anguilla">Anguilla</option>
<option value="Antarctica">Antarctica</option>
<option value="Antigua and Barbuda">Antigua and Barbuda</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</option>
<option value="Aruba">Aruba</option>
<option value="Australia">Australia</option>
<option value="Austria">Austria</option>
<option value="Azerbaijan">Azerbaijan</option>
<option value="Bahamas">Bahamas</option>
<option value="Bahrain">Bahrain</option>
<option value="Bangladesh">Bangladesh</option>
<option value="Barbados">Barbados</option>
<option value="Belarus">Belarus</option>
<option value="Belgium">Belgium</option>
<option value="Belize">Belize</option>
<option value="Benin">Benin</option>
<option value="Bermuda">Bermuda</option>
<option value="Bhutan">Bhutan</option>
<option value="Bolivia, Plurinational State of">Bolivia, Plurinational State of</option>
<option value="Bonaire, Sint Eustatius and Saba">Bonaire, Sint Eustatius and Saba</option>
<option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Bouvet Island">Bouvet Island</option>
<option value="Brazil">Brazil</option>
<option value="British Indian Ocean Territory">British Indian Ocean Territory</option>
<option value="Brunei Darussalam">Brunei Darussalam</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina Faso">Burkina Faso</option>
<option value="Burundi">Burundi</option>
<option value="Cambodia">Cambodia</option>
<option value="Cameroon">Cameroon</option>
<option value="Canada">Canada</option>
<option value="Cape Verde">Cape Verde</option>
<option value="Cayman Islands">Cayman Islands</option>
<option value="Central African Republic">Central African Republic</option>
<option value="Chad">Chad</option>
<option value="Chile">Chile</option>
<option value="China">China</option>
<option value="Christmas Island">Christmas Island</option>
<option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option>
<option value="Colombia">Colombia</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Congo, the Democratic Republic of the">Congo, the Democratic Republic of the</option>
<option value="Cook Islands">Cook Islands</option>
<option value="Costa Rica">Costa Rica</option>
<option value="Côte d'Ivoire">Côte d'Ivoire</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Curaçao">Curaçao</option>
<option value="Cyprus">Cyprus</option>
<option value="Czech Republic">Czech Republic</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica">Dominica</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="Ecuador">Ecuador</option>
<option value="Egypt">Egypt</option>
<option value="El Salvador">El Salvador</option>
<option value="Equatorial Guinea">Equatorial Guinea</option>
<option value="Eritrea">Eritrea</option>
<option value="Estonia">Estonia</option>
<option value="Ethiopia">Ethiopia</option>
<option value="Falkland Islands (Malvinas)">Falkland Islands (Malvinas)</option>
<option value="Faroe Islands">Faroe Islands</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="France">France</option>
<option value="French Guiana">French Guiana</option>
<option value="French Polynesia">French Polynesia</option>
<option value="French Southern Territories">French Southern Territories</option>
<option value="Gabon">Gabon</option>
<option value="Gambia">Gambia</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Gibraltar">Gibraltar</option>
<option value="Greece">Greece</option>
<option value="Greenland">Greenland</option>
<option value="Grenada">Grenada</option>
<option value="Guadeloupe">Guadeloupe</option>
<option value="Guam">Guam</option>
<option value="Guatemala">Guatemala</option>
<option value="Guernsey">Guernsey</option>
<option value="Guinea">Guinea</option>
<option value="Guinea-Bissau">Guinea-Bissau</option>
<option value="Guyana">Guyana</option>
<option value="Haiti">Haiti</option>
<option value="Heard Island and McDonald Islands">Heard Island and McDonald Islands</option>
<option value="Holy See (Vatican City State)">Holy See (Vatican City State)</option>
<option value="Honduras">Honduras</option>
<option value="Hong Kong">Hong Kong</option>
<option value="Hungary">Hungary</option>
<option value="Iceland">Iceland</option>
<option value="India">India</option>
<option value="Indonesia">Indonesia</option>
<option value="Iran, Islamic Republic of">Iran, Islamic Republic of</option>
<option value="Iraq">Iraq</option>
<option value="Ireland">Ireland</option>
<option value="Isle of Man">Isle of Man</option>
<option value="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jersey">Jersey</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Korea, Democratic People's Republic of">Korea, Democratic People's Republic of</option>
<option value="Korea, Republic of">Korea, Republic of</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Lao People's Democratic Republic">Lao People's Democratic Republic</option>
<option value="Latvia">Latvia</option>
<option value="Lebanon">Lebanon</option>
<option value="Lesotho">Lesotho</option>
<option value="Liberia">Liberia</option>
<option value="Libya">Libya</option>
<option value="Liechtenstein">Liechtenstein</option>
<option value="Lithuania">Lithuania</option>
<option value="Luxembourg">Luxembourg</option>
<option value="Macao">Macao</option>
<option value="Macedonia, the former Yugoslav Republic of">Macedonia, the former Yugoslav Republic of</option>
<option value="Madagascar">Madagascar</option>
<option value="Malawi">Malawi</option>
<option value="Malaysia">Malaysia</option>
<option value="Maldives">Maldives</option>
<option value="Mali">Mali</option>
<option value="Malta">Malta</option>
<option value="Marshall Islands">Marshall Islands</option>
<option value="Martinique">Martinique</option>
<option value="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</option>
<option value="Mayotte">Mayotte</option>
<option value="Mexico">Mexico</option>
<option value="Micronesia, Federated States of">Micronesia, Federated States of</option>
<option value="Moldova, Republic of">Moldova, Republic of</option>
<option value="Monaco">Monaco</option>
<option value="Mongolia">Mongolia</option>
<option value="Montenegro">Montenegro</option>
<option value="Montserrat">Montserrat</option>
<option value="Morocco">Morocco</option>
<option value="Mozambique">Mozambique</option>
<option value="Myanmar">Myanmar</option>
<option value="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="New Caledonia">New Caledonia</option>
<option value="New Zealand">New Zealand</option>
<option value="Nicaragua">Nicaragua</option>
<option value="Niger">Niger</option>
<option value="Nigeria">Nigeria</option>
<option value="Niue">Niue</option>
<option value="Norfolk Island">Norfolk Island</option>
<option value="Northern Mariana Islands">Northern Mariana Islands</option>
<option value="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Palestinian Territory, Occupied">Palestinian Territory, Occupied</option>
<option value="Panama">Panama</option>
<option value="Papua New Guinea">Papua New Guinea</option>
<option value="Paraguay">Paraguay</option>
<option value="Peru">Peru</option>
<option value="Philippines">Philippines</option>
<option value="Pitcairn">Pitcairn</option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Puerto Rico">Puerto Rico</option>
<option value="Qatar">Qatar</option>
<option value="Réunion">Réunion</option>
<option value="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</option>
<option value="Saint Barthélemy">Saint Barthélemy</option>
<option value="Saint Helena, Ascension and Tristan da Cunha">Saint Helena, Ascension and Tristan da Cunha</option>
<option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option>
<option value="Saint Lucia">Saint Lucia</option>
<option value="Saint Martin (French part)">Saint Martin (French part)</option>
<option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option>
<option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option>
<option value="Samoa">Samoa</option>
<option value="San Marino">San Marino</option>
<option value="Sao Tome and Principe">Sao Tome and Principe</option>
<option value="Saudi Arabia">Saudi Arabia</option>
<option value="Senegal">Senegal</option>
<option value="Serbia">Serbia</option>
<option value="Seychelles">Seychelles</option>
<option value="Sierra Leone">Sierra Leone</option>
<option value="Singapore">Singapore</option>
<option value="Sint Maarten (Dutch part)">Sint Maarten (Dutch part)</option>
<option value="Slovakia">Slovakia</option>
<option value="Slovenia">Slovenia</option>
<option value="Solomon Islands">Solomon Islands</option>
<option value="Somalia">Somalia</option>
<option value="South Africa">South Africa</option>
<option value="South Georgia and the South Sandwich Islands">South Georgia and the South Sandwich Islands</option>
<option value="South Sudan">South Sudan</option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Svalbard and Jan Mayen">Svalbard and Jan Mayen</option>
<option value="Swaziland">Swaziland</option>
<option value="Sweden">Sweden</option>
<option value="Switzerland">Switzerland</option>
<option value="Syrian Arab Republic">Syrian Arab Republic</option>
<option value="Taiwan, Province of China">Taiwan, Province of China</option>
<option value="Tajikistan">Tajikistan</option>
<option value="Tanzania, United Republic of">Tanzania, United Republic of</option>
<option value="Thailand">Thailand</option>
<option value="Timor-Leste">Timor-Leste</option>
<option value="Togo">Togo</option>
<option value="Tokelau">Tokelau</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad and Tobago">Trinidad and Tobago</option>
<option value="Tunisia">Tunisia</option>
<option value="Turkey">Turkey</option>
<option value="Turkmenistan">Turkmenistan</option>
<option value="Turks and Caicos Islands">Turks and Caicos Islands</option>
<option value="Tuvalu">Tuvalu</option>
<option value="Uganda">Uganda</option>
<option value="Ukraine">Ukraine</option>
<option value="United Arab Emirates">United Arab Emirates</option>
<option value="United Kingdom">United Kingdom</option>
<option value="United States">United States</option>
<option value="United States Minor Outlying Islands">United States Minor Outlying Islands</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Venezuela, Bolivarian Republic of">Venezuela, Bolivarian Republic of</option>
<option value="Viet Nam">Viet Nam</option>
<option value="Virgin Islands, British">Virgin Islands, British</option>
<option value="Virgin Islands, U.S.">Virgin Islands, U.S.</option>
<option value="Wallis and Futuna">Wallis and Futuna</option>
<option value="Western Sahara">Western Sahara</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
<option value="Zimbabwe">Zimbabwe</option>
</select>
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="delivery_tel">Mobile Number :</label>
<div class="col-sm-10">
<input type="text" class="form-control" placeholder="Enter Mobile Number" name="delivery_tel">
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="delivery_email">Email Id :</label>
<div class="col-sm-10">
<input type="text" class="form-control" placeholder="Enter Email Id" name="delivery_email">
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="i_have">I have :</label>
<div class="col-sm-10">
<select id="old" class="form-control" placeholder="Select I have" name="i_have">
<option value = "select_option">Select Option</option>
<option value = "three_compact">3 Compact</option>
<option value = "three_regular">3 Regular</option>
<option value = "three_triple">3 Triple</option>
<option value = "five_compact">5 Compact</option>
<option value = "five_regular">5 Regular</option>
<option value = "five_triple">5 Triple</option>
<option value = "seven_compact">7 Compact</option>
<option value = "seven_regular">7 Regular</option>
<option value = "seven_triple">7 Triple</option>
<option value = "nine_compact">9 Compact</option>
<option value = "nine_regular">9 Regular</option>
<option value = "nine_triple">9 Triple</option>
</select>
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="i_want">I want :</label>
<div class="col-sm-10">
<select id="new" class="form-control" placeholder="Select I want" name="i_want">
<option value = "select_option">Select Option</option>
<option value = "three_compact">3 Compact</option>
<option value = "three_regular">3 Regular</option>
<option value = "three_triple">3 Triple</option>
<option value = "five_compact">5 Compact</option>
<option value = "five_regular">5 Regular</option>
<option value = "five_triple">5 Triple</option>
<option value = "seven_compact">7 Compact</option>
<option value = "seven_regular">7 Regular</option>
<option value = "seven_triple">7 Triple</option>
<option value = "nine_compact">9 Compact</option>
<option value = "nine_regular">9 Regular</option>
<option value = "nine_triple">9 Triple</option>
</select>
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="price">Price (Rs) :</label>
<div class="col-sm-10">
<input type="text" class="form-control" id="price" name="price" readonly>
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="shipping_weight">Shipping Weight :</label>
<div class="col-sm-10">
<input type="text" class="form-control" id="shipping_weight" name="shipping_weight" readonly>
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="shipping_cost">Shipping Cost (Rs) :</label>
<div class="col-sm-10">
<select id="findata" class="form-control" id="shipping_cost" name="shipping_cost" ></select>
</div>
</div>
<div class="form-group">
<label class="control-label col-sm-2" for="grand_total">Grand Total: :</label>
<div class="col-sm-10">
<!-- <input type="text" class="form-control" id="grand_total" name="amount" readonly> -->
<input type="text" class="form-control" name="amount" value="1" readonly>
</div>
</div>
<div class="form-group">
<div class="col-sm-offset-2 col-sm-10">
<input type="hidden" name="tid" id="tid" readonly />
<input type="hidden" name="merchant_id" value="1234"/>
<input type="hidden" name="order_id" value="123654789"/>
<input type="hidden" name="currency" value="INR"/>
<!-- ####################################################################################### -->
<input type="hidden" name="redirect_url" value="https://abc.in/ccavResponseHandler.php"/>
<input type="hidden" name="cancel_url" value="https://abc.in/ccavResponseHandler.php"/>
<!-- ####################################################################################### -->
<inputtype="hidden" name="language" value="EN"/>
<button type="submit" class="btn btn-default" id="pass">Pay</button>
</div>
</div>
</form>
</div>
</body>
<!-- <button id="btn_check_value">Check for value</button> -->
<!-- Ajax Script -->
<script>
// Price
$(document).ready(function(){
$('#new').on('change',function(){
var old_val = $("#old option:selected").val();
var new_val = $("#new option:selected").val();
$.ajax({
type: "POST",
url: "ajax_price.php",
dataType: "text",
data: { old: old_val, new: new_val},
success: function(data)
{
// Check the output of ajax call on firebug console
// console.log(data);
$('#result').html(data);
$('#price').val(data);
}
});
});
});
// Weight
$(document).ready(function(){
$('#new').on('change',function(){
var old_val = $("#old option:selected").val();
var new_val = $("#new option:selected").val();
$.ajax({
type: "POST",
url: "ajax_ship_weight.php",
dataType: "text",
data: { old: old_val, new: new_val},
success: function(data)
{
// Check the output of ajax call on firebug console
//console.log(data);
$('#show').html(data);
$('#shipping_weight').val(data);
}
});
});
});
//Shipping_cost
$(document).ready(function(){
$('#new').on('change',function(){
var zip = $("#delivery_zip").val();
var country = $("#delivery_country").val();
$.ajax({
type: "POST",
// url: "ajax_ship_cost_data.php",
url: "sp_cost.php",
dataType: "text",
data: { delivery_zip: zip, delivery_country: country},
success: function(data)
{
// Check the output of ajax call on firebug console
//console.log(data);
$('#findata').html(data);
$('#shipping_cost').val(data);
}
});
});
});
// Grand Total
$(document).ready(function(){
$('#findata').on('change',function(){
var price = $("#price").val();
var shipping_cost = $("#findata").val();
$.ajax({
type: "POST",
url: "gt.php",
dataType: "text",
data: { price: price, shipping_cost: shipping_cost },
success: function(data)
{
// Check the output of ajax call on firebug console
// console.log(data);
$('#total').html(data);
$('#grand_total').val(data);
}
});
});
});
// ###### passing data to db #######
$(document).ready(function(){
$('#pass').on('click',function(){
var first_name = $("#first_name").val();
var last_name = $("#last_name").val();
var address = $("#address").val();
var city = $("#city").val();
var state_province = $("#state_province").val();
var zip_postal_code = $("#zip_postal_code").val();
var country = $("#country").val();
var email_id = $("#email_id").val();
var mobile_number = $("#mobile_number").val();
var i_have = $("#i_have").val();
var i_want = $("#i_want").val();
var price = $("#price").val();
var shipping_weight = $("#shipping_weight").val();
var shipping_cost = $("#shipping_cost").val();
var grand_total = $("#grand_total").val();
$.ajax({
type: "POST",
url: "ajax_data.php",
dataType: "text",
data:
{
first_name : first_name,
last_name : last_name,
address : address,
city : city,
state_province : state_province,
zip_postal_code : zip_postal_code,
country : country,
email_id : email_id,
mobile_number : mobile_number,
i_have : i_have,
i_want : i_want,
price : price,
shipping_weight : shipping_weight,
shipping_cost : shipping_cost,
grand_total : grand_total
},
// success: function(data)
// {
// Check the output of ajax call on firebug console
// console.log(data);
// $('#pass').html(data);
// $('#price').val(data);
// }
});
});
});
</script>
</html>
