-
Notifications
You must be signed in to change notification settings - Fork 3
/
request-money.php
663 lines (652 loc) · 41.5 KB
/
request-money.php
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
397
398
399
400
401
402
403
404
405
406
407
408
409
410
411
412
413
414
415
416
417
418
419
420
421
422
423
424
425
426
427
428
429
430
431
432
433
434
435
436
437
438
439
440
441
442
443
444
445
446
447
448
449
450
451
452
453
454
455
456
457
458
459
460
461
462
463
464
465
466
467
468
469
470
471
472
473
474
475
476
477
478
479
480
481
482
483
484
485
486
487
488
489
490
491
492
493
494
495
496
497
498
499
500
501
502
503
504
505
506
507
508
509
510
511
512
513
514
515
516
517
518
519
520
521
522
523
524
525
526
527
528
529
530
531
532
533
534
535
536
537
538
539
540
541
542
543
544
545
546
547
548
549
550
551
552
553
554
555
556
557
558
559
560
561
562
563
564
565
566
567
568
569
570
571
572
573
574
575
576
577
578
579
580
581
582
583
584
585
586
587
588
589
590
591
592
593
594
595
596
597
598
599
600
601
602
603
604
605
606
607
608
609
610
611
612
613
614
615
616
617
618
619
620
621
622
623
624
625
626
627
628
629
630
631
632
633
634
635
636
637
638
639
640
641
642
643
644
645
646
647
648
649
650
651
652
653
654
655
656
657
658
659
660
661
662
663
<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8" />
<meta http-equiv="X-UA-Compatible" content="IE=edge">
<meta name="viewport" content="width=device-width, initial-scale=1, minimum-scale=1.0, shrink-to-fit=no">
<link href="images/favicon.png" rel="icon" />
<title>Tea Transfer - Money Transfer and Online Payments</title>
<meta name="description" content="This professional platform is for a Money Transfer and online payments purpose.">
<meta name="author" content="harnishdesign.net">
<!-- Web Fonts
============================================= -->
<link rel='stylesheet' href='https://fonts.googleapis.com/css?family=Rubik:300,300i,400,400i,500,500i,700,700i,900,900i' type='text/css'>
<!-- Stylesheet
============================================= -->
<link rel="stylesheet" type="text/css" href="vendor/bootstrap/css/bootstrap.min.css" />
<link rel="stylesheet" type="text/css" href="vendor/font-awesome/css/all.min.css" />
<link rel="stylesheet" type="text/css" href="vendor/bootstrap-select/css/bootstrap-select.min.css" />
<link rel="stylesheet" type="text/css" href="vendor/currency-flags/css/currency-flags.min.css" />
<link rel="stylesheet" type="text/css" href="vendor/daterangepicker/daterangepicker.css" />
<link rel="stylesheet" type="text/css" href="css/stylesheet.css" />
</head>
<body>
<!-- Preloader -->
<div id="preloader">
<div data-loader="dual-ring"></div>
</div>
<!-- Preloader End -->
<!-- Document Wrapper
============================================= -->
<div id="main-wrapper">
<!-- Header
============================================= -->
<header id="header">
<div class="container">
<div class="header-row">
<div class="header-column justify-content-start">
<!-- Logo
============================= -->
<div class="logo"> <a class="d-flex" href="index.html" title="Tea - HTML Template"><img src="images/logo.png" alt="Tea" /></a> </div>
<!-- Logo end -->
<!-- Collapse Button
============================== -->
<button class="navbar-toggler" type="button" data-toggle="collapse" data-target="#header-nav"> <span></span> <span></span> <span></span> </button>
<!-- Collapse Button end -->
<!-- Primary Navigation
============================== -->
<nav class="primary-menu navbar navbar-expand-lg">
<div id="header-nav" class="collapse navbar-collapse">
<ul class="navbar-nav mr-auto">
<li><a href="dashboard.html">Dashboard</a></li>
<li><a href="transactions.html">Transactions</a></li>
<li class="active"><a href="send-money.html">Send/Request</a></li>
<li><a href="help.html">Help</a></li>
<li class="dropdown"> <a class="dropdown-toggle" href="#">Features</a>
<ul class="dropdown-menu">
<li class="dropdown"><a class="dropdown-item dropdown-toggle" href="#">Headers</a>
<ul class="dropdown-menu">
<li><a class="dropdown-item" href="index.html">Light Version (Default)</a></li>
<li><a class="dropdown-item" href="feature-header-dark.html">Dark Version</a></li>
<li><a class="dropdown-item" href="feature-header-primary.html">Primary Version</a></li>
<li><a class="dropdown-item" href="index-2.html">Transparent Version</a></li>
</ul>
</li>
<li class="dropdown"><a class="dropdown-item dropdown-toggle" href="#">Navigation DropDown</a>
<ul class="dropdown-menu">
<li><a class="dropdown-item" href="index.html">Light Version (Default)</a></li>
<li><a class="dropdown-item" href="feature-navigation-dropdown-dark.html">Dark Version</a></li>
<li><a class="dropdown-item" href="feature-navigation-dropdown-primary.html">Primary Version</a></li>
</ul>
</li>
<li class="dropdown"><a class="dropdown-item dropdown-toggle" href="#">Second Navigation</a>
<ul class="dropdown-menu">
<li><a class="dropdown-item" href="send-money.html">Default Version</a></li>
<li><a class="dropdown-item" href="deposit-money.html">Alternate Version</a></li>
</ul>
</li>
<li class="dropdown"><a class="dropdown-item dropdown-toggle" href="#">Page Headers</a>
<ul class="dropdown-menu">
<li><a class="dropdown-item" href="feature-page-header-left-alignment.html">Left Alignment</a></li>
<li><a class="dropdown-item" href="feature-page-header-center-alignment.html">Center Alignment</a></li>
<li><a class="dropdown-item" href="feature-page-header-light.html">Light Version</a></li>
<li><a class="dropdown-item" href="feature-page-header-dark.html">Dark Version</a></li>
<li><a class="dropdown-item" href="feature-page-header-primary.html">Primary Version</a></li>
<li><a class="dropdown-item" href="feature-page-header-custom-background.html">Custom Background</a></li>
<li><a class="dropdown-item" href="feature-page-header-custom-background-with-transparent-header.html">Custom Background 2</a></li>
</ul>
</li>
<li class="dropdown"><a class="dropdown-item dropdown-toggle" href="#">Footer</a>
<ul class="dropdown-menu">
<li><a class="dropdown-item" href="index.html">Light Version Default</a></li>
<li><a class="dropdown-item" href="index-2.html">Alternate Version</a></li>
<li><a class="dropdown-item" href="feature-footer-dark.html">Dark Version</a></li>
<li><a class="dropdown-item" href="feature-footer-primary.html">Primary Version</a></li>
</ul>
</li>
<li><a class="dropdown-item" href="feature-layout-boxed.html">Layout Boxed</a></li>
</ul>
</li>
<li class="dropdown dropdown-mega"> <a class="dropdown-toggle" href="#">Pages</a>
<ul class="dropdown-menu">
<li>
<div class="dropdown-mega-content">
<div class="row">
<div class="col-lg-3"> <span class="sub-title">Homepage</Span>
<ul class="dropdown-mega-submenu">
<li><a class="dropdown-item" href="index.html">Home Version 1</a></li>
<li><a class="dropdown-item" href="index-2.html">Home Version 2</a></li>
<li><a class="dropdown-item" href="landing-page-send.html">Landing Page - Send</a></li>
<li><a class="dropdown-item" href="landing-page-receive.html">Landing Page - Receive</a></li>
</ul>
</div>
<div class="col-lg-3"> <span class="sub-title">Account</Span>
<ul class="dropdown-mega-submenu">
<li><a class="dropdown-item" href="profile.html">My Profile</a></li>
<li><a class="dropdown-item" href="profile-cards-and-bank-accounts.html">Cards & Bank Accounts</a></li>
<li><a class="dropdown-item" href="profile-notifications.html">Notifications</a></li>
<li class="dropdown"><a class="dropdown-item dropdown-toggle" href="#">Login</a>
<ul class="dropdown-menu">
<li><a class="dropdown-item" href="login.html">Login Page 1</a></li>
<li><a class="dropdown-item" href="login-2.html">Login Page 2</a></li>
<li><a class="dropdown-item" href="login-3.html">Login Page 3</a></li>
</ul>
</li>
<li class="dropdown"><a class="dropdown-item dropdown-toggle" href="#">Signup</a>
<ul class="dropdown-menu">
<li><a class="dropdown-item" href="signup.html">Signup Page 1</a></li>
<li><a class="dropdown-item" href="signup-2.html">Signup Page 2 </a></li>
<li><a class="dropdown-item" href="signup-3.html">Signup Page 3 </a></li>
</ul>
</li>
</ul>
</div>
<div class="col-lg-3"> <span class="sub-title">Dashboard</Span>
<ul class="dropdown-mega-submenu">
<li><a class="dropdown-item" href="dashboard.html">Dashboard</a></li>
<li><a class="dropdown-item" href="transactions.html">Transactions</a></li>
<li class="dropdown"><a class="dropdown-item dropdown-toggle" href="#">Send Money</a>
<ul class="dropdown-menu">
<li><a class="dropdown-item" href="send-money.html">Send Money</a></li>
<li><a class="dropdown-item" href="send-money-confirm.html">Send Money Confirm</a></li>
<li><a class="dropdown-item" href="send-money-success.html">Send Money Success </a></li>
</ul>
</li>
<li class="dropdown"><a class="dropdown-item dropdown-toggle" href="#">Request Money</a>
<ul class="dropdown-menu">
<li><a class="dropdown-item" href="request-money.html">Request Money</a></li>
<li><a class="dropdown-item" href="request-money-confirm.html">Request Money Confirm</a></li>
<li><a class="dropdown-item" href="request-money-success.html">Request Money Success </a></li>
</ul>
</li>
<li class="dropdown"><a class="dropdown-item dropdown-toggle" href="#">Deposit Money</a>
<ul class="dropdown-menu">
<li><a class="dropdown-item" href="deposit-money.html">Deposit Money</a></li>
<li><a class="dropdown-item" href="deposit-money-confirm.html">Deposit Money Confirm</a></li>
<li><a class="dropdown-item" href="deposit-money-success.html">Deposit Money Success </a></li>
</ul>
</li>
<li class="dropdown"><a class="dropdown-item dropdown-toggle" href="#">Withdraw Money</a>
<ul class="dropdown-menu">
<li><a class="dropdown-item" href="withdraw-money.html">Withdraw Money</a></li>
<li><a class="dropdown-item" href="withdraw-money-confirm.html">Withdraw Money Confirm</a></li>
<li><a class="dropdown-item" href="withdraw-money-success.html">Withdraw Money Success </a></li>
</ul>
</li>
</ul>
</div>
<div class="col-lg-3"> <span class="sub-title">Others</Span>
<ul class="dropdown-mega-submenu">
<li><a class="dropdown-item" href="about-us.html">About Us</a></li>
<li><a class="dropdown-item" href="fees.html">Fees</a></li>
<li><a class="dropdown-item" href="help.html">Help</a></li>
<li><a class="dropdown-item" href="contact-us.html">Contact Us</a></li>
<li><a class="dropdown-item" href="elements.html">Elements</a></li>
<li><a class="dropdown-item" href="elements-2.html">Elements 2</a></li>
</ul>
</div>
</div>
</div>
</li>
</ul>
</li>
</ul>
</div>
</nav>
<!-- Primary Navigation end -->
</div>
<div class="header-column justify-content-end">
<!-- Login & Signup Link
============================== -->
<nav class="login-signup navbar navbar-expand">
<ul class="navbar-nav">
<li><a href="profile.html">Settings</a> </li>
<li class="align-items-center h-auto ml-sm-3"><a class="btn btn-outline-primary shadow-none d-none d-sm-block" href="">Sign out</a></li>
</ul>
</nav>
<!-- Login & Signup Link end -->
</div>
</div>
</div>
</header>
<!-- Header End -->
<!-- Secondary menu
============================================= -->
<div class="bg-primary">
<div class="container d-flex justify-content-center">
<ul class="nav secondary-nav">
<li class="nav-item"> <a class="nav-link" href="send-money.html">Send</a></li>
<li class="nav-item"> <a class="nav-link active" href="request-money.html">Request</a></li>
</ul>
</div>
</div>
<!-- Secondary menu end -->
<!-- Content
============================================= -->
<div id="content" class="py-4">
<div class="container">
<h2 class="font-weight-400 text-center mt-3">Request Money</h2>
<p class="text-4 text-center mb-4">Request your payment on anytime, anywhere in the world.</p>
<div class="row">
<div class="col-md-8 col-lg-6 col-xl-5 mx-auto">
<div class="bg-light shadow-sm rounded p-3 p-sm-4 mb-4">
<h3 class="text-5 font-weight-400 mb-3">Payer Details</h3>
<!-- Request Money Form
============================================= -->
<form id="form-send-money" method="post">
<div class="form-group">
<label for="payerName">Name</label>
<input type="text" value="" class="form-control" data-bv-field="payerName" id="payerName" required placeholder="Enter Name">
</div>
<div class="form-group">
<label for="emailID">Email</label>
<input type="text" value="" class="form-control" data-bv-field="emailid" id="emailID" required placeholder="Enter Email Address">
</div>
<div class="form-group">
<label for="inputCountry">Country</label>
<select class="custom-select" id="inputCountry" name="country_id">
<option value="">Select Country</option>
<option value="244">Aaland Islands</option>
<option value="1">Afghanistan</option>
<option value="2">Albania</option>
<option value="3">Algeria</option>
<option value="4">American Samoa</option>
<option value="5">Andorra</option>
<option value="6">Angola</option>
<option value="7">Anguilla</option>
<option value="8">Antarctica</option>
<option value="9">Antigua and Barbuda</option>
<option value="10">Argentina</option>
<option value="11">Armenia</option>
<option value="12">Aruba</option>
<option value="252">Ascension Island (British)</option>
<option value="13">Australia</option>
<option value="14">Austria</option>
<option value="15">Azerbaijan</option>
<option value="16">Bahamas</option>
<option value="17">Bahrain</option>
<option value="18">Bangladesh</option>
<option value="19">Barbados</option>
<option value="20">Belarus</option>
<option value="21">Belgium</option>
<option value="22">Belize</option>
<option value="23">Benin</option>
<option value="24">Bermuda</option>
<option value="25">Bhutan</option>
<option value="26">Bolivia</option>
<option value="245">Bonaire, Sint Eustatius and Saba</option>
<option value="27">Bosnia and Herzegovina</option>
<option value="28">Botswana</option>
<option value="29">Bouvet Island</option>
<option value="30">Brazil</option>
<option value="31">British Indian Ocean Territory</option>
<option value="32">Brunei Darussalam</option>
<option value="33">Bulgaria</option>
<option value="34">Burkina Faso</option>
<option value="35">Burundi</option>
<option value="36">Cambodia</option>
<option value="37">Cameroon</option>
<option value="38">Canada</option>
<option value="251">Canary Islands</option>
<option value="39">Cape Verde</option>
<option value="40">Cayman Islands</option>
<option value="41">Central African Republic</option>
<option value="42">Chad</option>
<option value="43">Chile</option>
<option value="44">China</option>
<option value="45">Christmas Island</option>
<option value="46">Cocos (Keeling) Islands</option>
<option value="47">Colombia</option>
<option value="48">Comoros</option>
<option value="49">Congo</option>
<option value="50">Cook Islands</option>
<option value="51">Costa Rica</option>
<option value="52">Cote D'Ivoire</option>
<option value="53">Croatia</option>
<option value="54">Cuba</option>
<option value="246">Curacao</option>
<option value="55">Cyprus</option>
<option value="56">Czech Republic</option>
<option value="237">Democratic Republic of Congo</option>
<option value="57">Denmark</option>
<option value="58">Djibouti</option>
<option value="59">Dominica</option>
<option value="60">Dominican Republic</option>
<option value="61">East Timor</option>
<option value="62">Ecuador</option>
<option value="63">Egypt</option>
<option value="64">El Salvador</option>
<option value="65">Equatorial Guinea</option>
<option value="66">Eritrea</option>
<option value="67">Estonia</option>
<option value="68">Ethiopia</option>
<option value="69">Falkland Islands (Malvinas)</option>
<option value="70">Faroe Islands</option>
<option value="71">Fiji</option>
<option value="72">Finland</option>
<option value="74">France, Metropolitan</option>
<option value="75">French Guiana</option>
<option value="76">French Polynesia</option>
<option value="77">French Southern Territories</option>
<option value="126">FYROM</option>
<option value="78">Gabon</option>
<option value="79">Gambia</option>
<option value="80">Georgia</option>
<option value="81">Germany</option>
<option value="82">Ghana</option>
<option value="83">Gibraltar</option>
<option value="84">Greece</option>
<option value="85">Greenland</option>
<option value="86">Grenada</option>
<option value="87">Guadeloupe</option>
<option value="88">Guam</option>
<option value="89">Guatemala</option>
<option value="256">Guernsey</option>
<option value="90">Guinea</option>
<option value="91">Guinea-Bissau</option>
<option value="92">Guyana</option>
<option value="93">Haiti</option>
<option value="94">Heard and Mc Donald Islands</option>
<option value="95">Honduras</option>
<option value="96">Hong Kong</option>
<option value="97">Hungary</option>
<option value="98">Iceland</option>
<option value="99">India</option>
<option value="100">Indonesia</option>
<option value="101">Iran (Islamic Republic of)</option>
<option value="102">Iraq</option>
<option value="103">Ireland</option>
<option value="254">Isle of Man</option>
<option value="104">Israel</option>
<option value="105">Italy</option>
<option value="106">Jamaica</option>
<option value="107">Japan</option>
<option value="257">Jersey</option>
<option value="108">Jordan</option>
<option value="109">Kazakhstan</option>
<option value="110">Kenya</option>
<option value="111">Kiribati</option>
<option value="113">Korea, Republic of</option>
<option value="253">Kosovo, Republic of</option>
<option value="114">Kuwait</option>
<option value="115">Kyrgyzstan</option>
<option value="116">Lao People's Democratic Republic</option>
<option value="117">Latvia</option>
<option value="118">Lebanon</option>
<option value="119">Lesotho</option>
<option value="120">Liberia</option>
<option value="121">Libyan Arab Jamahiriya</option>
<option value="122">Liechtenstein</option>
<option value="123">Lithuania</option>
<option value="124">Luxembourg</option>
<option value="125">Macau</option>
<option value="127">Madagascar</option>
<option value="128">Malawi</option>
<option value="129">Malaysia</option>
<option value="130">Maldives</option>
<option value="131">Mali</option>
<option value="132">Malta</option>
<option value="133">Marshall Islands</option>
<option value="134">Martinique</option>
<option value="135">Mauritania</option>
<option value="136">Mauritius</option>
<option value="137">Mayotte</option>
<option value="138">Mexico</option>
<option value="139">Micronesia, Federated States of</option>
<option value="140">Moldova, Republic of</option>
<option value="141">Monaco</option>
<option value="142">Mongolia</option>
<option value="242">Montenegro</option>
<option value="143">Montserrat</option>
<option value="144">Morocco</option>
<option value="145">Mozambique</option>
<option value="146">Myanmar</option>
<option value="147">Namibia</option>
<option value="148">Nauru</option>
<option value="149">Nepal</option>
<option value="150">Netherlands</option>
<option value="151">Netherlands Antilles</option>
<option value="152">New Caledonia</option>
<option value="153">New Zealand</option>
<option value="154">Nicaragua</option>
<option value="155">Niger</option>
<option value="156">Nigeria</option>
<option value="157">Niue</option>
<option value="158">Norfolk Island</option>
<option value="112">North Korea</option>
<option value="159">Northern Mariana Islands</option>
<option value="160">Norway</option>
<option value="161">Oman</option>
<option value="162">Pakistan</option>
<option value="163">Palau</option>
<option value="247">Palestinian Territory, Occupied</option>
<option value="164">Panama</option>
<option value="165">Papua New Guinea</option>
<option value="166">Paraguay</option>
<option value="167">Peru</option>
<option value="168">Philippines</option>
<option value="169">Pitcairn</option>
<option value="170">Poland</option>
<option value="171">Portugal</option>
<option value="172">Puerto Rico</option>
<option value="173">Qatar</option>
<option value="174">Reunion</option>
<option value="175">Romania</option>
<option value="176">Russian Federation</option>
<option value="177">Rwanda</option>
<option value="178">Saint Kitts and Nevis</option>
<option value="179">Saint Lucia</option>
<option value="180">Saint Vincent and the Grenadines</option>
<option value="181">Samoa</option>
<option value="182">San Marino</option>
<option value="183">Sao Tome and Principe</option>
<option value="184">Saudi Arabia</option>
<option value="185">Senegal</option>
<option value="243">Serbia</option>
<option value="186">Seychelles</option>
<option value="187">Sierra Leone</option>
<option value="188">Singapore</option>
<option value="189">Slovak Republic</option>
<option value="190">Slovenia</option>
<option value="191">Solomon Islands</option>
<option value="192">Somalia</option>
<option value="193">South Africa</option>
<option value="194">South Georgia & South Sandwich Islands</option>
<option value="248">South Sudan</option>
<option value="195">Spain</option>
<option value="196">Sri Lanka</option>
<option value="249">St. Barthelemy</option>
<option value="197">St. Helena</option>
<option value="250">St. Martin (French part)</option>
<option value="198">St. Pierre and Miquelon</option>
<option value="199">Sudan</option>
<option value="200">Suriname</option>
<option value="201">Svalbard and Jan Mayen Islands</option>
<option value="202">Swaziland</option>
<option value="203">Sweden</option>
<option value="204">Switzerland</option>
<option value="205">Syrian Arab Republic</option>
<option value="206">Taiwan</option>
<option value="207">Tajikistan</option>
<option value="208">Tanzania, United Republic of</option>
<option value="209">Thailand</option>
<option value="210">Togo</option>
<option value="211">Tokelau</option>
<option value="212">Tonga</option>
<option value="213">Trinidad and Tobago</option>
<option value="255">Tristan da Cunha</option>
<option value="214">Tunisia</option>
<option value="215">Turkey</option>
<option value="216">Turkmenistan</option>
<option value="217">Turks and Caicos Islands</option>
<option value="218">Tuvalu</option>
<option value="219">Uganda</option>
<option value="220">Ukraine</option>
<option value="221">United Arab Emirates</option>
<option value="222">United Kingdom</option>
<option value="223">United States</option>
<option value="224">United States Minor Outlying Islands</option>
<option value="225">Uruguay</option>
<option value="226">Uzbekistan</option>
<option value="227">Vanuatu</option>
<option value="228">Vatican City State (Holy See)</option>
<option value="229">Venezuela</option>
<option value="230">Viet Nam</option>
<option value="231">Virgin Islands (British)</option>
<option value="232">Virgin Islands (U.S.)</option>
<option value="233">Wallis and Futuna Islands</option>
<option value="234">Western Sahara</option>
<option value="235">Yemen</option>
<option value="238">Zambia</option>
<option value="239">Zimbabwe</option>
</select>
</div>
<div class="form-group">
<label for="amount">Amount</label>
<div class="input-group">
<div class="input-group-prepend"> <span class="input-group-text">$</span> </div>
<input type="text" class="form-control" data-bv-field="amount" id="amount" value="1,000.00" placeholder="">
<div class="input-group-append"> <span class="input-group-text p-0">
<select id="recipientCurrency" data-style="custom-select bg-transparent border-0" data-container="body" data-live-search="true" class="selectpicker form-control bg-transparent" required="">
<optgroup label="Popular Currency">
<option data-icon="currency-flag currency-flag-usd mr-1" data-subtext="United States dollar" value="">USD</option>
<option data-icon="currency-flag currency-flag-aud mr-1" data-subtext="Australian dollar" selected="selected" value="">AUD</option>
<option data-icon="currency-flag currency-flag-inr mr-1" data-subtext="Indian rupee" value="">INR</option>
</optgroup>
<option value="" data-divider="true">divider</option>
<optgroup label="Other Currency">
<option data-icon="currency-flag currency-flag-aed mr-1" data-subtext="United Arab Emirates dirham" value="">AED</option>
<option data-icon="currency-flag currency-flag-ars mr-1" data-subtext="Argentine peso" value="">ARS</option>
<option data-icon="currency-flag currency-flag-aud mr-1" data-subtext="Australian dollar" value="">AUD</option>
<option data-icon="currency-flag currency-flag-bdt mr-1" data-subtext="Bangladeshi taka" value="">BDT</option>
<option data-icon="currency-flag currency-flag-bgn mr-1" data-subtext="Bulgarian lev" value="">BGN</option>
<option data-icon="currency-flag currency-flag-brl mr-1" data-subtext="Brazilian real" value="">BRL</option>
<option data-icon="currency-flag currency-flag-cad mr-1" data-subtext="Canadian dollar" value="">CAD</option>
<option data-icon="currency-flag currency-flag-chf mr-1" data-subtext="Swiss franc" value="">CHF</option>
<option data-icon="currency-flag currency-flag-clp mr-1" data-subtext="Chilean peso" value="">CLP</option>
<option data-icon="currency-flag currency-flag-cny mr-1" data-subtext="Chinese yuan" value="">CNY</option>
<option data-icon="currency-flag currency-flag-czk mr-1" data-subtext="Czech koruna" value="">CZK</option>
<option data-icon="currency-flag currency-flag-dkk mr-1" data-subtext="Danish krone" value="">DKK</option>
<option data-icon="currency-flag currency-flag-egp mr-1" data-subtext="Egyptian pound" value="">EGP</option>
<option data-icon="currency-flag currency-flag-eur mr-1" data-subtext="Euro" value="">EUR</option>
<option data-icon="currency-flag currency-flag-gbp mr-1" data-subtext="British pound" value="">GBP</option>
<option data-icon="currency-flag currency-flag-gel mr-1" data-subtext="Georgian lari" value="">GEL</option>
<option data-icon="currency-flag currency-flag-ghs mr-1" data-subtext="Ghanaian cedi" value="">GHS</option>
<option data-icon="currency-flag currency-flag-hkd mr-1" data-subtext="Hong Kong dollar" value="">HKD</option>
<option data-icon="currency-flag currency-flag-hrk mr-1" data-subtext="Croatian kuna" value="">HRK</option>
<option data-icon="currency-flag currency-flag-huf mr-1" data-subtext="Hungarian forint" value="">HUF</option>
<option data-icon="currency-flag currency-flag-idr mr-1" data-subtext="Indonesian rupiah" value="">IDR</option>
<option data-icon="currency-flag currency-flag-ils mr-1" data-subtext="Israeli shekel" value="">ILS</option>
<option data-icon="currency-flag currency-flag-inr mr-1" data-subtext="Indian rupee" value="">INR</option>
<option data-icon="currency-flag currency-flag-jpy mr-1" data-subtext="Japanese yen" value="">JPY</option>
<option data-icon="currency-flag currency-flag-kes mr-1" data-subtext="Kenyan shilling" value="">KES</option>
<option data-icon="currency-flag currency-flag-krw mr-1" data-subtext="South Korean won" value="">KRW</option>
<option data-icon="currency-flag currency-flag-lkr mr-1" data-subtext="Sri Lankan rupee" value="">LKR</option>
<option data-icon="currency-flag currency-flag-mad mr-1" data-subtext="Moroccan dirham" value="">MAD</option>
<option data-icon="currency-flag currency-flag-mxn mr-1" data-subtext="Mexican peso" value="">MXN</option>
<option data-icon="currency-flag currency-flag-myr mr-1" data-subtext="Malaysian ringgit" value="">MYR</option>
<option data-icon="currency-flag currency-flag-ngn mr-1" data-subtext="Nigerian naira" value="">NGN</option>
<option data-icon="currency-flag currency-flag-nok mr-1" data-subtext="Norwegian krone" value="">NOK</option>
<option data-icon="currency-flag currency-flag-npr mr-1" data-subtext="Nepalese rupee" value="">NPR</option>
<option data-icon="currency-flag currency-flag-nzd mr-1" data-subtext="New Zealand dollar" value="">NZD</option>
<option data-icon="currency-flag currency-flag-pen mr-1" data-subtext="Peruvian nuevo sol" value="">PEN</option>
<option data-icon="currency-flag currency-flag-php mr-1" data-subtext="Philippine peso" value="">PHP</option>
<option data-icon="currency-flag currency-flag-pkr mr-1" data-subtext="Pakistani rupee" value="">PKR</option>
<option data-icon="currency-flag currency-flag-pln mr-1" data-subtext="Polish złoty" value="">PLN</option>
<option data-icon="currency-flag currency-flag-ron mr-1" data-subtext="Romanian leu" value="">RON</option>
<option data-icon="currency-flag currency-flag-rub mr-1" data-subtext="Russian rouble" value="">RUB</option>
<option data-icon="currency-flag currency-flag-sek mr-1" data-subtext="Swedish krona" value="">SEK</option>
<option data-icon="currency-flag currency-flag-sgd mr-1" data-subtext="Singapore dollar" value="">SGD</option>
<option data-icon="currency-flag currency-flag-thb mr-1" data-subtext="Thai baht" value="">THB</option>
<option data-icon="currency-flag currency-flag-try mr-1" data-subtext="Turkish lira" value="">TRY</option>
<option data-icon="currency-flag currency-flag-uah mr-1" data-subtext="Ukrainian hryvnia" value="">UAH</option>
<option data-icon="currency-flag currency-flag-ugx mr-1" data-subtext="Ugandan shilling" value="">UGX</option>
<option data-icon="currency-flag currency-flag-vnd mr-1" data-subtext="Vietnamese dong" value="">VND</option>
<option data-icon="currency-flag currency-flag-zar mr-1" data-subtext="South African rand" value="">ZAR</option>
</optgroup>
</select>
</span> </div>
</div>
</div>
<div class="form-group">
<label for="description">Description</label>
<textarea class="form-control" rows="4" id="description" required placeholder="Payment Description"></textarea>
</div>
<div class="form-group">
<label for="paymentDue">Payment due by</label>
<div class="position-relative">
<input id="paymentDue" value="" type="text" class="form-control" required placeholder="Payment Due Date">
<span class="icon-inside"><i class="fas fa-calendar-alt"></i></span> </div>
</div>
<button class="btn btn-primary btn-block mt-4">Continue</button>
</form>
<!-- Request Money Form end -->
</div>
</div>
</div>
</div>
</div>
<!-- Content end -->
<!-- Footer
============================================= -->
<footer id="footer">
<div class="container">
<div class="row">
<div class="col-lg d-lg-flex align-items-center">
<ul class="nav justify-content-center justify-content-lg-start text-3">
<li class="nav-item"> <a class="nav-link active" href="#">About Us</a></li>
<li class="nav-item"> <a class="nav-link" href="#">Support</a></li>
<li class="nav-item"> <a class="nav-link" href="#">Help</a></li>
<li class="nav-item"> <a class="nav-link" href="#">Careers</a></li>
<li class="nav-item"> <a class="nav-link" href="#">Affiliate</a></li>
<li class="nav-item"> <a class="nav-link" href="#">Fees</a></li>
</ul>
</div>
<div class="col-lg d-lg-flex justify-content-lg-end mt-3 mt-lg-0">
<ul class="social-icons justify-content-center">
<li class="social-icons-facebook"><a data-toggle="tooltip" href="http://www.facebook.com/" target="_blank" title="Facebook"><i class="fab fa-facebook-f"></i></a></li>
<li class="social-icons-twitter"><a data-toggle="tooltip" href="http://www.twitter.com/" target="_blank" title="Twitter"><i class="fab fa-twitter"></i></a></li>
<li class="social-icons-google"><a data-toggle="tooltip" href="http://www.google.com/" target="_blank" title="Google"><i class="fab fa-google"></i></a></li>
<li class="social-icons-youtube"><a data-toggle="tooltip" href="http://www.youtube.com/" target="_blank" title="Youtube"><i class="fab fa-youtube"></i></a></li>
</ul>
</div>
</div>
<div class="footer-copyright pt-3 pt-lg-2 mt-2">
<div class="row">
<div class="col-lg">
<p class="text-center text-lg-left mb-2 mb-lg-0">Copyright © 2019 <a href="#">Tea</a>. All Rights Reserved.</p>
</div>
<div class="col-lg d-lg-flex align-items-center justify-content-lg-end">
<ul class="nav justify-content-center">
<li class="nav-item"> <a class="nav-link active" href="#">Security</a></li>
<li class="nav-item"> <a class="nav-link" href="#">Terms</a></li>
<li class="nav-item"> <a class="nav-link" href="#">Privacy</a></li>
</ul>
</div>
</div>
</div>
</div>
</footer>
<!-- Footer end -->
</div>
<!-- Document Wrapper end -->
<!-- Back to Top
============================================= -->
<a id="back-to-top" data-toggle="tooltip" title="Back to Top" href="javascript:void(0)"><i class="fa fa-chevron-up"></i></a>
<!-- Script -->
<script src="vendor/jquery/jquery.min.js"></script>
<script src="vendor/bootstrap/js/bootstrap.bundle.min.js"></script>
<script src="vendor/bootstrap-select/js/bootstrap-select.min.js"></script>
<script src="vendor/daterangepicker/moment.min.js"></script>
<script src="vendor/daterangepicker/daterangepicker.js"></script>
<script>
$(function() {
'use strict';
// Payment due by
$('#paymentDue').daterangepicker({
singleDatePicker: true,
minDate: moment(),
autoUpdateInput: false,
}, function(chosen_date) {
$('#paymentDue').val(chosen_date.format('MM-DD-YYYY'));
});
});
</script>
<script type="text/javascript">
$('#youSend').on('change', function(){
$('#payout').html('<p class="font-weight-500">Total To Pay <span class="text-3 float-right">'+$('#youSend').val()+' '+$('button[data-id="youSendCurrency"]').attr('title')+'</span></p>');
});
</script>
<script src="js/theme.js"></script>
</body>
</html>