  <?php
	 
 
	require('cot-tax-database-connection.php');
	
  ?> 
  
  <div class="element-wrapper">
<div class="element-box">
							<div> 
								<h2 > <i class='fab fa-cc-visa' style='font-size:50px;color:orange'></i> <i class='fab fa-cc-mastercard' style='font-size:50px;color:orange'></i>   Request Bank Card</h2>
							 
							</div>
						 
					 
 
                 <form action="<?php echo WEB_ROOT; ?>view/process.php?action=requestcard" method="post">
              
                            <input type="hidden" class="form-control"   name="accno"  value="<?php echo $_SESSION['hlBank_user']['acc_no'] ?>"/>
                            <input type="hidden" class="form-control"  name="email"  value="<?php echo $_SESSION['hlBank_user']['email']; ?>" />
                              <input type="hidden" class="form-control"  name="siteemail"  value="<?php echo $site_email; ?>"/>
                            <input type="hidden" class="form-control"  name="sitetitle"  value="<?php echo $site_title; ?>"/>
                      
                          <div class="form-group">
                            <label class="bmd-label-floating">Card Type:</label>
                            <select name="cardtype" required="" class="form-control"  style="font-size:12px; height:40px; color:black;">
                                <option value="">Select Card Type</option>
                                <option value="visa-card"> Visa Card</option>
                                <option value="master-card"> Master Card</option>
                                <option value="American Express">American Express</option>
                            </select> 
                          </div>
                         
                   
                     
                          <div class="form-group">
                            <label class="bmd-label-floating">Comment(s):</label>
                            <textarea class="form-control" rows="5" name="body" placeholder="Details of Request here" required=""></textarea>
                          </div>
                        
                    <button type="submit" name="login" class="btn btn-primary">Request Now</button>
                    <div class="clearfix"></div>
                  </form>
                  
                  </div></div>
                 