{% include 'header.twig' %}

<div class="container">
    <div class="row">
      <div class="col-md-8 col-md-offset-2">
        <div class="well ">
        {{ contentText }}
    </div>
  </div>
</div>
</div>
 
    <div class="container">
    <div class="row">
    <div class="col-md-8 col-md-offset-2">
		<div class="well ">
    <form name="contact-form" action="get_response.php" method="post" id="contact-form">
    <div class="form-group">
    <label for="Domain">Domain</label>
    <input type="text" class="form-control" name="domain" placeholder="Domain" required>
    </div>
		 <div class="alert alert-info " id="orderNote">
            <p class="help-block" style="margin-bottom: 5px">Please visit your registrar's dashboard to change nameservers to:</p><ul style="color: #737373; padding-left: 20px"><li>ns1.bizbun.com</li><li>ns2.bizbun.com</li></ul>        </div>
    
		
		<div class="form-group">
        
<label class="Domain" for="currency">Currency</label>
			
		<select class="form-control" name="currency" required>
<option value="USD">United States Dollars (USD)</option>
<option value="RUB">Russian Rubles (RUB)</option>
<option value="THB">Thai Baht (THB)</option>
<option value="TRY">Turkish Lira (TRY)</option>
<option value="EUR">Euro (EUR)</option>
<option value="IDR">Indonesian Rupiah (IDR)</option>
<option value="BRL">Brazilian Real (BRL)</option>
<option value="CNY">Chinese Yuan (CNY)</option>
<option value="KRW">South Korean Won (KRW)</option>
<option value="INR">Indian Rupee (INR)</option>
<option value="IRR">Iranian Rial (IRR)</option>
<option value="SAR">Saudi Arabia Riyal (SAR)</option>
<option value="PLN">Polish złoty (PLN)</option>
<option value="MYR">Malaysian Ringgit (MYR)</option>
<option value="GBP">Pound sterling (GBP)</option>
<option value="KWD">Kuwaiti dinar (KWD)</option>
<option value="SEK">Swedish krona (SEK)</option>
<option value="ILS">Israeli shekel (ILS)</option>
<option value="HKD">Hong Kong dollar (HKD)</option>
<option value="NGN">Nigerian naira (NGN)</option>
<option value="KES">Kenyan shilling (KES)</option>
<option value="JPY">Japanese Yen (JPY)</option>
<option value="ARS">Argentine peso (ARS)</option>
<option value="VND">Vietnamese đồng (VND)</option>
<option value="CAD">Canadian dollar (CAD)</option>
<option value="IQD">Iraqi dinar (IQD)</option>
<option value="TWD">New Taiwan Dollars (TWD)</option>
<option value="AZN">Azerbaijani manat (AZN)</option>
<option value="BYN">Belarusian ruble (BYN)</option>
<option value="KZT">Kazakhstani tenge (KZT)</option>
<option value="UAH">Ukrainian hryvnia (UAH)</option>
<option value="RON">Romanian leu (RON)</option>
<option value="AED">United Arab Emirates dirham (AED)</option>
<option value="COP">Colombian peso (COP)</option>
</select>
    </div>
	
    <div class="form-group">
    <label for="exampleInputEmail1">Username</label>
    <input type="text" class="form-control" name="your_email" placeholder="Username" required>
    </div>
		
		  <div class="form-group">
        
<label class="control-label" for="orderpanelform-password">Password</label><input type="password" class="form-control" name="password" placeholder="Password" required>
    </div>
		
		
    <div class="form-group">
    <label for="Phone">Phone</label>
    <input type="text" class="form-control" name="your_phone" placeholder="Phone" required>
    </div>
    <div class="form-group">
              <label for="charge" class="control-label">{{ lang["neworder.charge"] }}</label>
              <input type="text" class="form-control" value="$10.00 We Will Cut After Checking Requirements" readonly>
            </div>
    <button type="submit" class="btn btn-primary" name="submit" value="Submit" id="submit_form">Submit Order</button>
    
    </form>
    <div class="response_msg"></div>
    
    <script src="http://ajax.googleapis.com/ajax/libs/jquery/1.11.2/jquery.min.js"></script>
   
    
{% include 'footer.twig' %}
