source: db_tsh/Views/Home/Payment.cshtml@ 705d6f5

@model db_tsh.Models.Payment
@{
    ViewData["Title"] = "Payment";
}

<div class="container mt-5">
    <div class="row justify-content-center">
        <div class="col-md-6">
            <div class="card">
                <div class="card-header bg-success text-white">
                    <h3 class="card-title">Payment</h3>
                </div>
                <div class="card-body">
                    <form asp-action="Payment" method="post">
                        <div class="form-group">
                            <label for="policyId">Policy ID</label>
                            <input type="text" class="form-control" id="policyId" name="policyId" value="@Model.PolicyId" readonly>
                        </div>
                        <div class="form-group">
                            <label for="PAmount">Payment Amount</label>
                            <input type="number" class="form-control" id="PAmount" name="PAmount" placeholder="Enter payment amount" value="@Model.PAmount" required readonly>
                        </div>
                        <div class="form-group">
                            <label for="PDate">Payment Date</label>
                            <input type="date" class="form-control" id="PDate" name="PDate" required>
                        </div>
                        <div class="form-group">
                            <label for="visaNumber">Visa Number</label>
                            <input type="text" class="form-control" id="visaNumber" name="visaNumber" placeholder="Enter your visa number" required>
                        </div>
                        <button type="submit" class="btn btn-success btn-block">Submit Payment</button>
                    </form>
                </div>
            </div>
        </div>
    </div>
</div>