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<meta http-equiv="Content-Type" content="text/html; charset=windows-1251"></meta>
<title>Выставление счёта за покупку</title>
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</head>
<body>
<div style="margin:0 0; padding:5px; width: 396px; border:1px solid #ddd; background:#fff; border-radius: 7px; -webkit-border-radius: 7px; -moz-border-radius: 7px; font:normal 14px/14px Geneva,Verdana,Arial,Helvetica,Tahoma,sans-serif;">
<form action="http://w.qiwi.ru/setInetBill.do" method="post" accept-charset="windows-1251" onSubmit="return checkSubmit();">
<input type="hidden" name="from" value=""/>
<input type="hidden" name="lifetime" value=""/>
<input type="hidden" name="check_agt" value="true"/>
<!-- используйте это поле для передачи уникального идентификатора заказа/платежа в вашей системе -->
<!-- <input type="hidden" name="txn_id" value=""/> -->
<p style="text-align:center; color:#006699; padding:20px 0px; background:url(https://ishop.qiwi.ru/img/button/logo_31x50.jpg) no-repeat 10px 50%;">Выставить счёт за покупку</p>
<table style="border-collapse:collapse;">
<tr style="background:#f1f5fa;">
<td style="color:#a3b52d; width:45%; text-align:center; padding:10px 0px;">Мобильный телефон (пример: 9057772233)</td>
<td style="padding:10px">
<input type="text" name="to" id="idto" style="width:50px; text-align:right; border: 1px inset #555;"></input>
<span id="div_idto"></span>
<script type="text/javascript">
inputMasks["idto"] = new Mask (document.getElementById("idto"));
function checkSubmit() {
if (inputMasks["idto"].getValue().match(/^\d{10}$/)) {
document.getElementById("idto").setAttribute("disabled", "disabled");
inputMasks["idto"].makeHInput();
return true;
} else {
alert("Введите номер телефона в федеральном формате без \"8\" и без \"+7\"");
return false;
}
}
</script>
</td>
</tr>
<tr>
<td style="color:#a3b52d; padding:10px 0px; width:45%; text-align:center;">Сумма</td>
<td style="padding:10px">
<input type="text" name="amount_rub" value="10" maxlength="5" style="width:50px; text-align:right; border: 1px inset #555;" /> руб.
<input type="text" name="amount_kop" value="0" maxlength="2" size="2" style="width:50px; text-align:right; border: 1px inset #555;"/> коп.
</td>
</tr>
<tr style="background:#f1f5fa;">
<td style="color:#a3b52d; padding:10px 0px; width:45%; text-align:center;"></td>
<td style="padding:10px"><input type="text" name="com" value="Пополнение баланса проекта WILAXIA"style="width:150px; border: 1px inset #555;"></td>
</tr>
</table>
<p style="text-align:center;"><input type="submit" value="Пополнить баланс" style=" padding:10px 0;border:none; background:url(https://ishop.qiwi.ru/img/button/superBtBlue.jpg) no-repeat 0 50%; color:#fff; width:300px;"/></p>
</form>
Автор скрипта XwiruS <a href="http://wilaxia.ru">Wilaxia.ru</a>
</div>
</body>
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