<style type="text/css">
	/* Chrome, Safari, Edge, Opera */
input::-webkit-outer-spin-button,
input::-webkit-inner-spin-button {
  -webkit-appearance: none;
  margin: 0;
}

/* Firefox */
input[type=number] {
  -moz-appearance: textfield;
}

input{
	padding: 10px;

}
select{
	padding: 12px;
	display: block !important;
	background-image: none;
}
input[type="text"].dNone{
	border-color: black !important;
	border-width: 1px;
}
label.error{
	color:red;
}
</style>


<form action="https://cloudsclover.com/wc-api/pixel_pago_external_response/" method="post" id="formInfo">

<div class="row">
	<div class="col-12">
		<h4></h4>
	</div>

<div class="col-6">
<p>
		<label for="nombreUsuario">First Name</label><br>
	<input type="text" class="dNone" name="nombreUsuario" placeholder="First Name"  id="nombreUsuario" style="width: 100%;" />
	<br>
	</p>
</div>
<div class="col-6">
<p>
		<label for="apellidoUsuario">Last Name</label><br>
	<input class="dNone" type="text" name="apellidoUsuario" placeholder="Last Name" id="apellidoUsuario" style="width: 100%;"/>
	<br>
	</p>
</div>
<div class="col-3">
<p>
		<label for="NumTarjeta">Card number</label>
	<input class="dNone input-mask" data-inputmask="'mask':'xxxx xxxx xxxx xxxx'" type="number" name="NumTarjeta" placeholder="Card number" id="NumTarjeta" style="width: 100%;"/>
	<br>
	</p>
</div>

<div class="col-3">
	<p>
		<label for="cvv">CVV</label>
	<input class="dNone" type="number" name="cvv" placeholder="CVV" id="cvv" style="width: 100%;"/>
	<br>
	</p>
</div>
<div class="col-3">
	<p>
		<label for="mesCad">Month</label>
	<select class="dNone" name="mesCad" id="mesCad" style="width: 100%; display: block !important;" >
		<option value="01">01</option>
		<option value="02">02</option>
		<option value="03">03</option>
		<option value="04">04</option>
		<option value="05">05</option>
		<option value="06">06</option>
		<option value="07">07</option>
		<option value="08">08</option>
		<option value="09">09</option>
		<option value="10">10</option>
		<option value="11">11</option>
		<option value="12">12</option>
	</select>
	<br>
	</p>
</div>
<div class="col-3">
	<p>
		<label for="anioCad">Year</label>
    <select class="dNone"  name="anioCad" id="anioCad" style="width: 100%; display: block !important;">
    	<!--<option value="default">Seleccione una opción...</option>-->
    </select>
    <br>
    <input type="hidden" name="id" value="">
	</p>
</div>

<div class="col-sm-12 text-center fame-contact fame-form">
<p>
	<button type="submit" class="wpcf7-form-control wpcf7-submit btn btn-primary btn-send text-center">Send</button>
</p>
</div>

</div>

</form><style type="text/css">
	/* Chrome, Safari, Edge, Opera */
input::-webkit-outer-spin-button,
input::-webkit-inner-spin-button {
  -webkit-appearance: none;
  margin: 0;
}

/* Firefox */
input[type=number] {
  -moz-appearance: textfield;
}

input{
	padding: 10px;

}
select{
	padding: 12px;
	display: block !important;
	background-image: none;
}
input[type="text"].dNone{
	border-color: black !important;
	border-width: 1px;
}
label.error{
	color:red;
}
</style>


<form action="https://cloudsclover.com/wc-api/pixel_pago_external_response/" method="post" id="formInfo">

<div class="row">
	<div class="col-12">
		<h4></h4>
	</div>

<div class="col-6">
<p>
		<label for="nombreUsuario">First Name</label><br>
	<input type="text" class="dNone" name="nombreUsuario" placeholder="First Name"  id="nombreUsuario" style="width: 100%;" />
	<br>
	</p>
</div>
<div class="col-6">
<p>
		<label for="apellidoUsuario">Last Name</label><br>
	<input class="dNone" type="text" name="apellidoUsuario" placeholder="Last Name" id="apellidoUsuario" style="width: 100%;"/>
	<br>
	</p>
</div>
<div class="col-3">
<p>
		<label for="NumTarjeta">Card number</label>
	<input class="dNone input-mask" data-inputmask="'mask':'xxxx xxxx xxxx xxxx'" type="number" name="NumTarjeta" placeholder="Card number" id="NumTarjeta" style="width: 100%;"/>
	<br>
	</p>
</div>

<div class="col-3">
	<p>
		<label for="cvv">CVV</label>
	<input class="dNone" type="number" name="cvv" placeholder="CVV" id="cvv" style="width: 100%;"/>
	<br>
	</p>
</div>
<div class="col-3">
	<p>
		<label for="mesCad">Month</label>
	<select class="dNone" name="mesCad" id="mesCad" style="width: 100%; display: block !important;" >
		<option value="01">01</option>
		<option value="02">02</option>
		<option value="03">03</option>
		<option value="04">04</option>
		<option value="05">05</option>
		<option value="06">06</option>
		<option value="07">07</option>
		<option value="08">08</option>
		<option value="09">09</option>
		<option value="10">10</option>
		<option value="11">11</option>
		<option value="12">12</option>
	</select>
	<br>
	</p>
</div>
<div class="col-3">
	<p>
		<label for="anioCad">Year</label>
    <select class="dNone"  name="anioCad" id="anioCad" style="width: 100%; display: block !important;">
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    </select>
    <br>
    <input type="hidden" name="id" value="">
	</p>
</div>

<div class="col-sm-12 text-center fame-contact fame-form">
<p>
	<button type="submit" class="wpcf7-form-control wpcf7-submit btn btn-primary btn-send text-center">Send</button>
</p>
</div>

</div>

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