<div class="modal-header">
	<button type="button" class="close" data-ng-click="cancel()">×</button>
	<h3>Online Card Payment</h3>
</div>
<form class="form-horizontal" data-ng-submit="save()">
	<div class="modal-body">
		<div class="control-group">
			<label class="control-label label-required" for="inputAmount">Amount</label>
			<div class="controls">
				<div class="input-prepend">
					<span class="add-on">£</span>
					<input type="text" id="inputAmount" data-ng-model="data.amount" numbers-only required>
				</div>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label label-required" for="inputCardNumber">Card Number</label>
			<div class="controls">
				<div class="input-prepend">
					<span class="add-on"><i class="fa fa-credit-card"></i></span>
					<input type="text" id="inputCardNumber" data-ng-model="data.card_number" placeholder="The long number on front of the card" numbers-only required>
				</div>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label label-required" for="inputCardNumber">Expiry Date</label>
			<div class="controls">
					<select name="month" ng-model="data.exp_month" ng-options="option as option for option in months" style="width: 70px;" required><option value="">--MM--</option></select>
					<select name="year" ng-model="data.exp_year" ng-options="option as option for option in years" style="width: 100px;" required><option value="">--Year--</option></select>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label label-required" for="inputCVC">CVC</label>
			<div class="controls">
				<div class="input-prepend">
					<span class="add-on"><i class="fa fa-lock"></i></span>
					<input type="text" id="inputCVC" data-ng-model="data.cvc" placeholder="3 digit number from the back of the card" numbers-only required>
				</div>
			</div>
		</div>
		<div class="control-group">
			<label class="control-label" for="inputNotes">Notes</label>
			<div class="controls">
				<textarea id="inputNotes" data-ng-model="data.notes" style="width: 95%;"></textarea>
			</div>
		</div>
	</div>
	<div class="modal-footer">
		<button class="btn" data-ng-click="cancel()" eat-click>Close</button>
		<button class="btn btn-primary" ng-disabled="loading"><i class="fa fa-spinner fa-spin" ng-show="loading"></i> Take Payment</button>
	</div>
</form>