gistfile1

= form_for @subscription, :html => { 'data-stripe-key' => "#{STRIPE_PUBLISHABLE_KEY}" } do |f|
  = f.hidden_field :stripe_customer_token
  = f.hidden_field :last4
  = f.hidden_field :exp_month
  = f.hidden_field :exp_year
  = f.hidden_field :plan_id
  .panel.userForm.active
    .featurehead
      h1 Payment Information
      fieldset.reg.docmail
        = error_messages_for :subscription, header_message: "There were errors during your subscription", message: nil, class: "registration_error_message"
        // credit card
        hr
        h2 Credit Card
        p
          label
            em.em
              sup *
              |  Credit Card Number
            = text_field_tag :card_number, nil, name: nil, class: "long", placeholder: @subscription.last4.blank? ? '' : "************#{@subscription.last4}"
        p.multi
          label
            em.em
              sup *
              |  Expiration Date
            = select_month Date.new(@subscription.exp_year.to_i, @subscription.exp_month.to_i), {add_month_numbers: true}, {name: nil, id: "card_month"}
          label
            em.em
              |  
            = select_year Date.new(@subscription.exp_year.to_i, @subscription.exp_month.to_i), {start_year: Date.today.year, end_year: Date.today.year+15}, {name: nil, id: "card_year"}
          .clear
          p.multi
            label
              em.em
                sup *
                | Security Code
              = text_field_tag :card_code, nil, name: nil, class: "short", placeholder: @subscription.last4.blank? ? '' : '***'
            label
              em.em
              br
              em Visa, MC, Discover: 3-digits
              em American Express: 4-digits
          .clear
          p
            label
              em.em
                |  Promotional Code
              = f.text_field :stripe_promo_code, :placeholder => "Optional", :class => "medium"

        // name
        h2 Billing Information
        p.multi
          label
            em.em
              sup *
              |  First Name
            = f.text_field :firstname, :placeholder => "", :class => "mediumer", :size => "30"
          label
            em.em
              sup *
              |  Last Name
            = f.text_field :lastname, :placeholder => "", :class => "mediumer", :size => "30"
        .clearfix
        p
          label
            em.em
              sup *
              |  Billing Email
            = f.text_field :email, :placeholder => "Email", :class => "longer"
        p
          label
            em.em
              sup *
              |  Billing Address
            = f.text_field :address_line1, :placeholder => "Street", :class => "longer"
          label
            = f.text_field :address_line2, :placeholder => "If Applicable", :class => "longer"
        p.multi
          label
            em.em
              sup *
              |  City
            = f.text_field :city, :placeholder => "City", :class => "medium"
          label
            em.em
              sup *
              |  State
            = f.select :state, State.options_for_select, :class => "zip"
          label
            em.em
              sup *
              |  Zip
            = f.text_field :postal_code, :placeholder => "Zip", :class => "zip"
 
            = f.hidden_field :country, :value => "US"
        .clearfix
        p
          label
            em.em
              sup *
              |  Billing Phone
            = f.text_field :phone_number, :placeholder => "", :class => "medium"
        p
          label.tic
            = f.check_box :policy_agreement, :class => "left"
            em.left
              | By checking this box, you agree to the
              a href="/privacy#pp8" target="_blank" Refund Policy.
              br
              |  Your paid account will be renewed automatically. You can cancel anytime.
        .clearfix
        hr
        p.buttonset
          button.next#submit_recruiter_subscription.button Review Order