ikan Uploader :
Directory : /var/www/html/shardahospital_old.org/application/views/
Upload File : |
| Current File : /var/www/html/shardahospital_old.org/application/views/reviewbooking.php |
<?php include('includes/header.php'); ?>
<!--BreadcrumbsStart-->
<section id="breadcrumbs">
<div class="container van-booking-head">
<div class="row">
<div class="col-md-12">
<h1>Aarogya Mammography Van Booking</h1>
</div>
<div class="col-md-12">
<ul>
<li><a href="/">Sharda Hospital</a></li>
<li>Aarogya Mammography Van Booking</li>
</ul>
</div>
</div>
</div>
</section>
<!--BreadcrumbsEnd-->
<!--MainDIV-Start-->
<section id="main">
<div class="container">
<div class="row">
<div id="contact_us">
<form method="post" name="customerData" id="customerData" action="<?php echo site_url('Payment/vanbookingpayment'); ?>">
<div class="col-md-6 col-sm-6">
<ul class="list-unstyled width list1">
<input type="hidden" name="view_respcode" id="view_respcode" value="<?=$orderDetails['id']?>" >
<li><h4>Registration No</h4>
<?=$orderDetails['booking_id']?>
</li>
<li><h4>Name of the Rotary Club</h4>
<?=$orderDetails['club_name']?>
</li>
<li><h4>Email Address</h4>
<?=$orderDetails['email_id']?>
</li>
<li><h4>Name of Contact Person</h4>
<?=$orderDetails['contact_person']?>
</li>
<li><h4>Road Condition to Reach Camp</h4>
<?=$orderDetails['road_condition']?>
</li>
<li><h4>Expected No. of Patients to Attend the camp</h4>
<?=$orderDetails['expected_no']=='' ? 'NA' : $orderDetails['expected_no']?>
</li>
<li><h4>Address</h4>
<?=$orderDetails['full_address']?> <br/>
<?=$orderDetails['city']?>, <?=$orderDetails['state']?>, <?=$orderDetails['country']?> - <?=$orderDetails['pincode']?>
</li>
<li><h4>Booking Ammount</h4>
<p>Rs. 10,000</p>
</li>
</ul>
</div>
<div class="col-md-6 col-sm-6">
<ul class="list-unstyled list1">
<li><h4>Date of Booking</h4>
<?=date('d-m-Y',strtotime($orderDetails['booking_date']))?>
</li>
<li><h4>Name of Camp Site</h4>
<?=$orderDetails['camp_site_name']?>
</li>
<li><h4>Distance from Sharda Hospital , Greater Noida</h4>
<?=$orderDetails['distance_from_shospital']?>
</li>
<li><h4>Contact No.</h4>
<?=$orderDetails['contact_no']?>
</li>
<li><h4>Alternative Contact No.(if any Available)</h4>
<?=$orderDetails['alternate_contact_no']=='' ? 'NA' : $orderDetails['alternate_contact_no']?>
</li>
<li><h4>Mode of Payment</h4>
<p>Online</p>
</li>
</ul>
</div>
<div class="col-md-12 col-xs-12">
<input type="hidden" name="merchant_param1" value="" />
<input type="hidden" name="merchant_param2" value="Aarogya Mammography Van Booking" />
<input type="hidden" name="merchant_param3" value="<?php echo $OrderItemID ?>" />
<input type="hidden" name="merchant_param4" value="Sharda Hospital" />
<input type="hidden" name="tid" id="tid" value="<?php echo $OrderItemID ?>" readonly />
<input type="hidden" name="merchant_id" value="160146" />
<input type="hidden" name="order_id" value="<?=$orderDetails['booking_id']?>" required readonly />
<input type="hidden" name="redirect_url" value="<?php echo site_url('Payment/bookingresponse'); ?>" readonly />
<input type="hidden" name="cancel_url" value="<?php echo site_url('Payment/bookingresponse'); ?>" readonly />
<input type="hidden" name="language" value="EN"/>
<input type="hidden" name="customer_identifier" value=""/>
<a href="https://www.shardahospital.org/van-booking?resp=<?=$_GET['resp']?>" class="btn_orange btn-default back button2" style="float:left;">Back</a> <button type="submit" value="CheckOut" class="btn_orange btn-default submit xs-btn">Confirm & Pay Now</button></div>
</form>
</div>
</div>
</div>
</section>
<?php include('includes/footer.php'); ?>
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