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test.html
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<!DOCTYPE html>
<html>
<head>
<link
rel="stylesheet"
href="https://maxcdn.bootstrapcdn.com/bootstrap/4.3.1/css/bootstrap.min.css"
/>
</head>
<body>
<form action="/monthly" method="post">
<div>
<h3>Donation Amount</h3>
<input type="hidden" name="typeOfDonation" value="monthly" />
<div class="row">
<div class="form-group">
<div class="radio-select col-lg-2">
<input value="100" type="radio" id="amount-1" name="sel-amount" />
<label for="amount-1">₹100</label>
</div>
<div class="radio-select col-lg-2">
<input
value="1000"
type="radio"
id="amount-2"
name="sel-amount"
/>
<label for="amount-2">₹1000</label>
</div>
<div class="radio-select col-lg-2">
<input
value="2000"
type="radio"
id="amount-3"
name="sel-amount"
/>
<label for="amount-3">₹2000</label>
</div>
<div class="radio-select col-lg-2">
<input
value="10000"
type="radio"
id="amount-4"
name="sel-amount"
/>
<label for="amount-4">₹10,000</label>
</div>
<div class="radio-select col-lg-4">
<input
type="radio"
name="sel-amount"
value="custom"
id="customAmountRadioM"
/>
<label for="customAmountRadioM">
<input
type="text"
name="custom"
id="customAmountInputM"
value=""
/>
</label>
</div>
<script>
const customAmountRadioM =
document.getElementById("customAmountRadioM");
const customAmountInputM =
document.getElementById("customAmountInputM");
customAmountRadioM.addEventListener("change", function () {
customAmountInputM.disabled = !this.checked;
if (this.checked) {
customAmountInputM.focus();
}
});
</script>
</div>
</div>
</div>
<hr />
<!--Form Portlet-->
<div id="donator-details">
<h3>Donor Details</h3>
<div class="row">
<div class="form-group col-lg-6 col-md-6 col-xs-12">
<div class="field-label">First Name</div>
<input
type="text"
placeholder="Enter First Name"
value=""
id="first"
name="name"
/>
</div>
<div class="form-group col-lg-6 col-md-6 col-xs-12">
<div class="field-label">Last Name</div>
<input
type="text"
placeholder="Enter Last Name"
value=""
id="last"
name="name"
/>
</div>
<div class="form-group col-lg-6 col-md-6 col-xs-12">
<div class="field-label">Pan Number</div>
<input
type="text"
placeholder="Enter PAN"
value=""
id="pan"
name="name"
/>
</div>
<div class="form-group col-lg-6 col-md-6 col-xs-12">
<div class="field-label">Email</div>
<input
type="email"
placeholder="Enter Email"
value=""
id="eml"
name="name"
/>
</div>
<div class="form-group col-lg-6 col-md-6 col-xs-12">
<div class="field-label">Phone</div>
<input
type="tel"
placeholder="Enter Phone"
value=""
id="phone"
name="name"
/>
</div>
<div class="form-group col-lg-6 col-md-6 col-xs-12">
<div class="field-label">Address</div>
<input
type="text"
placeholder="Address"
value=""
id="addr"
name="name"
/>
</div>
<div class="form-group col-lg-6 col-md-6 col-xs-12">
<div class="field-label">Enter City</div>
<input
type="text"
placeholder="Enter City Name"
value=""
id="city"
name="name"
/>
</div>
<div class="form-group col-lg-6 col-md-6 col-xs-12">
<div class="field-label">Zip / Postal Code</div>
<input
type="number"
placeholder="Zip Code"
value=""
id="zip"
name="name"
/>
</div>
<hr />
<div class="text-right form-group col-lg-12 col-md-12 col-xs-12">
<button id="donate-now-btn" class="btn btn-secondary" type="submit">
Donate Now
</button>
<script src="https://checkout.razorpay.com/v1/checkout.js"></script>
</div>
</div>
</div>
<hr />
</form>
</body>
</html>