<?php $this->load->view("top_application"); ?>
<div class="db-list-com tz-db-table dir-pa-sp-top">
  <div class="container">
    <div class="row">
      <div class="col-lg-12">
        <h2 class="text-center"><strong>Online Payment</strong></h2>
        <br>
      </div>
      <div class="col-lg-12">
        <div class="hom-cre-acc-left hom-cre-acc-right">
          <form id="contactform" action="" name="contactform" method="post">
            <div class="row">
              <?php echo validation_message(); ?>
              <?php echo error_message(); ?>
              <div class="input-field col s6">
                <input name="package_name" readonly type="text" class="validate packageDets" value="<?php echo $package['package_name']; ?> Package" />
              </div>
              <div class="input-field col s6">
                <input name="amount" type="text" readonly class="validate packageDets" value="<?php echo $package['price']*12; ?>" />
                <label>Price per year</label>
              </div>
              <div class="input-field col s3">
                <input name="first_name" type="text" value="<?php echo $mres['first_name']; ?>" class="validate" required>
                <label>First Name</label>
              </div>
              <div class="input-field col s3">
                <input name="last_name" type="text" value="<?php echo $mres['last_name']; ?>" class="validate" required>
                <label>Last Name</label>
              </div>
              <div class="input-field col s6">
                <input name="email" type="email" value="<?php echo $mres['user_email']; ?>" class="validate" required>
                <label>Email Address</label>
              </div>
              <div class="input-field col s6">
                <input name="mobile" type="text" value="<?php echo $mres['mobile_number']; ?>" class="validate" required>
                <label>Mobile Number</label>
              </div>
              <div class="input-field col s6">
                <input name="company" type="text" value="<?php echo $mres['company_name']; ?>" class="validate">
                <label>Company Name</label>
              </div>
            </div>
            <div class="row">
              <div class="input-field col s4 v2-mar-top-40"> 
                <button type="submit" class="waves-effect waves-light btn-large full-btn">Submit</button>
              </div>
            </div>
          </form>
        </div>
      </div>
    </div>
  </div>
</div>
<section class="upgrade" style="background-image:url(<?php echo theme_url(); ?>images/banner01.jpg);background-color:#151f31;">
  <div class="container">
    <h3>Ready to Grow Your Business?</h3>
    <div class="links">
      <span>Upgrade to Gold membership</span>
      <a href="">Chat with Sales</a></div>
  </div>
</section>
<section class="partner">
  <div class="container">
    <div class="row">
      <div class="col-lg-6 col-md-6">
        <div class="hom-cre-acc-left">
          <small>* Additional taxes may apply based on your country/region. All membership plans are billed annually.</small>
          <p>Payment Security (128-bit SSL Encryption): <img src="<?php echo theme_url(); ?>images/payment.png" alt="payment"></p>
          <p>Natural Therapy India Partners: <img src="<?php echo theme_url(); ?>images/payment.png" alt="payment"></p>

        </div>
      </div>
      <div class="col-lg-6 col-md-6">
        <p><strong>Not sure which plan is right for you?</strong></p>
        <p>Contact us and we’ll help you find the right plan for your business.</p>
        <p><i class="fa fa-envelope"></i> goldsupplier@member.Natural Therapy India<br>
          <i class="fa fa-phone"></i> +91-99112-44888</p>
      </div>
    </div>
  </div>
</section>
<?php $this->load->view("bottom_application"); ?>