<%- # License: AGPL-3.0-or-later WITH Web-Template-Output-Additional-Permission-3.0-or-later -%>
<% card_holder_name ||= current_user && !current_user.profile.full_name.blank? #XXX blech %>

<div class='u-background--grey group u-padding--8'>
	<fieldset>
		<input type='text' class='input-medium' name='name'
			required
			parsley-trigger='change'
			placeholder="Cardholders' Name">
			<!--= set_value donate_wiz.supporter.name -->
			<!--= set_value card_form.preset_name -->
			<!--= set_value selected_supporter.name -->
	</fieldset>

	<fieldset class='col-8'>
		<input type='text' name='number'
			required
			parsley-trigger='blur'
			parsley-card-number
			placeholder="Card Number">
	</fieldset>

	<fieldset class='col-right-4 u-relative'>
		<input type='text' name='cvc'
			parsley-trigger='change'
			placeholder='CVC'>
		<%= image_tag 'graphics/cc-security-code.png', :class => 'security-code-image' %>
	</fieldset>

	<fieldset class='col-4 u-margin--0'>
		<select name='exp_month' class='select' required parsley-trigger='change'>
			<option value='' class='default' selected>Month</option>
			<% (1..12).each do |month| %>
				<option><%= month.to_s %></option>
			<% end %>
		</select>
	</fieldset>

	<fieldset class='col-left-4 u-margin--0'>
		<select name='exp_year' class='select' required parsley-trigger='change'>
			<option value='' class='default' selected>Year</option>
			<% expiration_years.each do |year| %>
				<option><%= year %></option>
			<% end %>
		</select>
	</fieldset>

	<fieldset class='col-right-4 u-margin--0'>
		<input type='text' name='address_zip'
			parsley-rangelength="[5,5]"
			parsley-trigger="change"
			required
			value=''
			placeholder='Postal Code'>
	</fieldset>

	<input type='hidden' name='profile_id' value='<%= GetData.chain(current_user, :profile, :id) %>'>
</div>